Wednesday, January 6, 2010

Faith and Medicine: What is the Doctor's Responsibility?

If Wendy Cadge is saying with this article that because 3/4 of Americans believe God can cure those with no chance of survival, doctors should entertain that belief and stop being so technology-oriented, this article at the Christian Science Monitor is not only irresponsible but silly. She writes:

Modern medicine, with its profound dependence on technology, often seems nothing short of miraculous. But even the best medicine sometimes falls short of offering a successful treatment or cure. It is in these situations that recent national surveys show many Americans think God can help.

Indeed, three-quarters of Americans believe God can cure people who have been given no chance of survival by medical science. More than half of Americans regularly pray for their own health or the health of their family. Yet many physicians are unwilling, or ill-equipped, to support patients and families on this level.

Many doctors see religion and spirituality as a barrier to medical care or, at most, a useful crutch when medicine has no more answers. But healing involves more than just medical diagnosis and treatment. Often patients and families see spirituality as a source of support when they are ill, or appear to be dying.

A holistic approach to medicine requires physicians to understand the complex role of spirituality and religion in compassionate patient care. The best prescription: Integrate these topics throughout medical education.

Appear to be dying?" Doctors ill-equipped to encourage families for a holy miracle? Godly healing is the new frontier in medicine? Medicine "sometimes falls short of a cure"? Um, statistically, we all die. So 100% of the time, medicine is eventually going to fall short of a cure. While faith is an enduring and credible support in grief, it cannot heal a patient. (Millions of federal dollars have been spent the past decades to prove that prayer aids healing. They all proved it doesn't.)

Cadge talks to a number of physicians - about 30 - and finds that few really know what to do when patients want to discuss their faith or pray with them. She concludes that this is a problem, caused by poor "faith" and "spirituality" training in medical school:

This may be changing, however, as a growing number of medical schools – many with the support of the George Washington Institute of Spirituality and Health (GWish) – started offering courses about spirituality and religion during the past 20 years. These courses try to prepare students to engage in a broad range of conversations about spirituality and religion. Individual courses vary significantly, however, leading GWish to collaborate with medical schools to develop six core competencies in spiritual and health education and to design a uniform way to measure and evaluate them.

While such top-down efforts are a good beginning, it’s clear that most practicing physicians have at least some level of discomfort regarding spirituality in their work, and some consider it a real source of conflict. Our bottom-up research approach – based on talking to physicians in the field – convinces us that a more nuanced, flexible approach to helping doctors and medical students navigate the spiritual shoals is needed.

That bottom-up approach was talking to 30 doctors informally about religion and spirituality. And she then recommends how lack of spiritual understanding in doctors it can be remedied:

First, physician educators must pay attention to the way they and their colleagues act around spirituality and religion in their work. Too many debates about spirituality in medicine are focused on what physicians should do rather than what they are actually doing now.


Second, doctors should pay more attention both to people’s religious traditions and to their broader senses of spirituality and meaning.


Third, it makes sense to systematically include hospital chaplains and nurses in educational initiatives. Two-thirds of American hospitals have chaplains, and nurses have a much longer tradition of talking with patients about spirituality and religion at the bedside than do physicians. Nurses also often spend more time with patients than do physicians

I don't even know what the first point means.

The second, in a broad sense, has validity. All humans should be sensitive to other's religious and spiritual beliefs.

The third is a great recommendation - but one that is already addressed at the 624 Catholic hospitals in the US and all others, despite secular or denominational affiliation who employ chaplains, priests, and buddhist guides.

The doctor's job, however, is a science-based job. And while doctors are required, by definition, to focus on science, they are also members of society, a society that is infused with religion and spirituality.

What I suspect Cadge's concern is about is end of life counseling. Elsewhere in the article she asserts that, "A holistic approach to taking care of people, one that will most help those who seek healing, means that more doctors will have to begin to understand patients’ complex relationships to spirituality and religion, rather than ignoring them."

She never clearly defines what she means by a "holistic approach to taking care of people."

If she means participating in religious practices like prayer or helping patients to look to God for a cure when medicine fails, I think she is misguided in her assignation of responsibilities for doctors.

Yes, doctor's notoriously need to improve their people skills but sympathizing with a patient's faith is not the same as helping them to pray for a miracle.

I know I'll get a lot of criticism for this post, particularly from my more "discerning" readers who will find it more proof that I'm anti-Christian or anti-relgion or that I don't believe in miracles. They'll be right with the latter point. And I find encouraging terminal patients to believe in miracles only an exacerbation of an already dire problem in the medical field: inability to talk realistically about unfavorable diagnoses or impending death.

Despite what Cadge claims, the medical profession has long abandoned dying patients to their pastors and priests. Medicine and faith have been intertwined from the beginning (as she inadvertently notes with her opening sentence about miraculous medicine.) They have recognized that when their science no longer works, it is easier to allow a patient who does not want to accept death to take up entertaining miracles with their faith leader.

Cadge's diagnosis that doctors should encourage hope for miracles is letting doctors without the personal skills to speak frankly with dying patients off the hook. I'm not at all saying that all patients can accept impending death. Some choose to fight on, to pray for reprieve from God and their disease, to forego the preparations for death in lieu of eternal hope. That's fine.

Although studies have shown that issues of grief are often better handled by families whose loved one accepted death and prepared for it. A doctor's role is not to encourage nor discourage such belief but to report his findings as accurately as possible and in a manner that does not cause emotional or physical harm to the patient.

Expecting spiritual guidance from doctors is asking too much. Clear discussion of diagnoses, compassion, scientific dexterity and sticking around til the end are a doctor's duties.

UPDATE: With regard to the questionable quality and accuracy of another Christian Science Monitor article, I linked to this post and the Cadge article on a listserve I subscribe to (feminist topics). One person replied saying that I was misreading Cadge, that she was petitioning for spiritual and religious sensitivity for doctors. I replied with the below. Am I off the mark on this one? Let me know in email or comments:

I agree that doctor sensitivity to faith is absolutely necessary. But informed consent implies the doctor ethically informs of options, the patient consents according to his/her conscience. My point is that sensitivity to faith and reticence to addressimpending death should not blur those roles.

A March study shows that devout patients are 3 times more likely to receive futile care at end of life than the less devout. A NYT article from August says due to lack of training on how to talk about death doctors are bad at prognosticating because they "view it as a personal failure. Most predictions are overly optimistic...and the sicker the patient, the more likely the doctor is to overestimate the length of survival." Futile care often leads to a more painful death, and great emotional challenges for the family. Rampant patient over-treatment is preventing our medical system from addressing those most in need.

The CSM piece laments that "only a quarter of the physicians surveyed reported having received any formal training at the intersection of spirituality, religion, and medicine."

Not to be obtuse but what is that intersection for a doctor? Does it mean that the medically sound diagnosis for pancreatic cancer is any different for a Atheist or a Muslim than it is for a Christian? And why is increased spiritual or religious sensitivity necessary for, say, palliative doctors but not OB/GYNs?

How information is conveyed is a matter of sensitivity. What information is conveyed is not.

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Pseudoscience, Junk Science in Politicized Discourse.

The ubiquitous Jill Stanek, great lover of babies, abstinence and God, has a column at WorldNetDaily titled, "Under Obama, STD Super Strains All the Rage." It's an absolutely star example of unscientific, unreasoned fear-mongering in politicized media, meant to make the point that the evil Obama administration - and liberal policies in general - are infecting citizens with increasingly untreatable strains of diseases. Stanek scribbles:

Recalling the Rev. Jeremiah Wright once famously accused the "government … [of] inventing the HIV virus as a means of genocide against people of color," it is ironic that his protégé, Barack Obama, along with other carriers of the deadly diseases of political correctness and liberal ideology, would actually be the ones guilty of spreading not only HIV but other plagues.

Political correctness is loose conservative code for anti-discriminatory language or tolerance or something like that. It developed to make racists aware of how ignorant and discriminatory they were. Liberal ideology is as nebulous a term. For conservatives, it can stand in for anything found objectionable. And the reference to Jeremiah Wright is a great starter for Stanek's like-minded readers who know exactly were the article is going without reading it. Wright's paranoid accusation that HIV was unleashed to kill blacks, perfectly linked to the left and the sitting president, is taking a (black) exception as representative of all thought on the left regarding disease - not credible.

Stanek cites three news reports about resistant strains of disease, the first on resistant strains of tuberculosis, the second about the rise of sexually transmitted diseases, and the third about the ban lifted on HIV positive travelers into the US. She claims that while these three stories have nothing in common - and they don't - that she will prove they do.

Her non-argument:

To begin connecting the dots, Homeland Security Today on Dec. 29 reported on the scale of diseases resistant to drug treatment:

[P]hysicians and researchers around the world are expressing growing alarm over the disturbing escalation of a variety of antibiotic-resistant diseases they say are rapidly mutating. Some … fear these diseases will evolve into dominate strains for which we have no new antibiotics to treat the level of resistance that we are now witnessing.

Why is this happening? The Associated Press reported in the aforementioned Juarez piece:

Today, all the leading killer infectious diseases on the planet – TB, malaria and HIV among them – are mutating at an alarming rate, hitchhiking their way in and out of countries. The reason: Overuse and misuse of the very drugs that were supposed to save us.

Just as the drugs were a manmade solution to dangerous illness, the problem with them is also manmade. It is fueled worldwide by everything from counterfeit drugmakers to the unintended consequences of giving drugs to the poor without properly monitoring their treatment.

Then she throws in scary reports of drug-resistant malaria in Cambodia and Africa (as if it's one country) and the rise of animal-to-human cross-over diseases. Scared yet? If any recent report mentions disease or drug-resistance, apparently she's determined to cobble them together to prove that the Obama administration is working to perpetuate policy that aids the spread of these diseases.Then Stanek breaks into the nether realm of illogic:

So states legislating the distribution of antibiotics for unverified cases of sexually transmitted diseases are only making matters worse.

Speaking of, England's Venereal Diseases Act of 1917 defined three: chancroid, gonorrhea andsyphilis, all bacterial.

Today there are over 25 viral (incurable) and bacterial (with hundreds of strains, many antibiotic resistant) STDs.

Interestingly, widespread use of the birth-control pill beginning in the 1960s is being partially blamed for the spread of STDs for two reasons, the increased number of sexual partners and decreased use of condoms.

Today contraceptive advocates suggest using condoms in conjunction with birth-control pills. They also recommend stocking morning-after pills in the medicine cabinet for feared failure of the first two as well as keeping a dental dam (don't ask) in the night stand to guard against infections caught from oral sex.

Meanwhile, they call abstinence education stupid.

Get it? Birth control is the cause of new strains of drug-resistant diseases around the world! From Malaria to TB, from gonorrhea to syphillis. Stanek concludes the poorly-strung piece with a quote from Homeland Security Today that reports on the spread of drug-resistant TB. The report, by Anthony Kimerly, states only that those with HIV are more susceptible to TB because their immune system is weakened by the former. She concludes with:

Political correctness and liberal ideology both cause and aggravate the spread of communicable and sexually transmitted diseases.

And these people want to take over the American health-care system.

According to Susan Jacoby, there are five primary characteristics of Junk Thought. There are:

1. Confusion of coincidence and causation:

Stanek comes to the information with an already-formed premise: that the Obama administration's policies are bad for the health of the nation and lethal to quality health care. Running the conservative screed, she also wants to show that current foreign policy is deadly. The information she gathers to make this point has only tangential applicability to the rise of TB in the world (the 1917 British Venereal Disease Act? Health Care Reform? The birth control pill?)

Her assertion that the advent of the birth control pill caused an increase in venereal disease infections (nobody in Westernized countries loses a nose to siphillis today), more sexual partners (actually a change in social mores, divorce rates and women's equality since the sixties - and by the way, alone not a bad thing), and decreased use of condoms (the use of which has been hampered by abstinence teaching and funding here and around the world) are all conjecture. She doesn't have a single fact to back any of it up and she confuses advent of the pill with these issues, ignoring that other factors had an impact as well.

2. Appropriation of scientific-sounding language for emotional stories that are used as representative of fact but are unreasoned:

Citing credible sources but using faulty logic to string them together, she throws out the AP (not always credible, I should note), the World Health Organization, Homeland Security Today as though provide her premise with legitimacy. But her effort is to cause an emotional reaction of fear and anger in her readers that masquerades as science. The peppering of numbers and dates make it look like she knows what she's talking about.

3. Innumeracy, or sloppy numbers:

Despite a plethora of credible studies that conclusively show that abstinence education causes increased spread of sexually transmitted disease in the US, she makes her own conclusions based on ideology - because she does not want to believe in the facts. She prefers to cling to unproven but "pure" ideas of abstinence and human behavior.

4. Definitions so broad as to be meaningless:

Disease, sexually transmitted viruses, global politics, abstinence education (quite different in the US than in Uganda, Kenya or Cambodia): Stanek neglects to differentiate between sexually transmitted and air-born viruses, global travel issues (she's got no facts on how many HIV travelers will come to the US, nor on how many of those have drug-resistant TB but uses fear of infection to make the possibilities credible). And she conflates STDs and HIV infection.

5. Expert-bashing which keeps the public confused on the legitimacy of science and facts and prevents clear distinction between pseudo science and good, tested, provable science:

By criticizing policies unpopular among conservatives, health care reform and immigration, she has an audience ready to take her assertions at face value. That the smart people in government can't see the facts plays into existing fear of a black president, terrorism, and health concerns. Never mind that she's got no way to prove that all these disparate factors - coincidence of HIV and TB infection, the lifting of the ban on HIV travel, the revision of health care, and abstinence education - are in any way related.

We're not encouraged to logically or scientifically analyze news information. We live in an environment that runs on outrage, fear and conjecture. Were common readers able or willing to assess the information that passes their way on it's scientific and factual merit, they would better grasp the ideological motives behind such "reports." But in a culture where intelligent design is taught in schools and man is considered to be made in God's image, proof too seldom plays a role in how we govern our actions and our country country.

For all the science that have proven abstinence education doesn't work, Stanek and her contingency cling to the belief that it will solve social problems like teenage pregnancy, the spread of STDs - and sadly, the move to treat women with equality in society. But facts and current human behavior prove otherwise.

If her objective is to reduce these challenges in society (STD infection, teenage pregnancy, HIV), logically Stanek would be the greatest proponent of birth control on the planet. Condoms again and again have been proven to work. But, sadly, that's not her objective. And sadly, she's still spreading unfounded ideology far and wide.

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