Medicine and its tension with faith

“I see you haven’t had your flu shot this year, Mrs. Adams. Would you like to get it now?”

“Nice try!” she replied playfully, her warm smile conveying a serene confidence forged by seven long, difficult decades on this earth. “But you know I never get the flu shot.”

“I know,” I said, still hopeful I could change her mind, “but influenza can be very dangerous, particularly in patients over the age of –’’

“I know you’re just doing your job. And I really do appreciate it. But the Lord’s been watching over me for years,” she said, chuckling softly, “and I think He knows that it’s flu season.”

***

Recent outbreaks of measles, the resurgence of pertussis, and the ever menacing presence of influenza, a virus known to mutate and decimate entire populations, have all led to renewed interest in the topic of vaccination. Media stories of declining regional immunization rates abound, and physicians everywhere are left wondering why anyone would refuse such an effective primary prevention measure, how anyone could possibly ignore the sound science supporting it.

These are reasonable reactions. After all, providing quality care based on the best available science is a challenging endeavor that can also be quite frustrating, particularly when patients disregard medical advice for “unscientific” reasons. But dismissing these patients as ignorant, viewing them as less intelligent or responsible than their more compliant counterparts, is not only counterproductive but also wrongheaded. It marginalizes them, belittles their legitimate concerns. And that sort of intellectual vanity also devalues one of our country’s richest traditions: faith.

Throughout human history, faith has played a central role in how individuals understand the physical universe; how they view disease, illness, and their own mortality; how they form relationships. And the word “faith” denotes much more than belief in God or adherence to a particular set of religious doctrines. It also encompasses all of the ways in which we innately make sense of the human condition and includes an inherent trust in family, friends, and our own instincts.

Even physicians rely on much more than scientific evidence when diagnosing and treating illness. Tradition, intuition, and distinct worldviews, for better or worse, all profoundly impact their therapeutic approach. Faith, whether disguised as a trusted colleague’s advice, previous patient anecdotes, or even visceral “whispers,” accompanies all physicians into the exam room. Indeed, it is intrinsically human to view the world, and resolve scientific “fact,” through the prism of one’s own values and experiences.

And yet many people, including scientists and other professionals expected to rely solely on the tangible, have trouble consciously reconciling faith with science, deeming the former less valid than the latter. But I would argue that, in today’s society, both are invaluable and inextricably linked, one perpetually challenging the other, endowing it with context, as part of an inexorable quest for an increasingly illusive truth. Simply stated, in an imperfect world, particularly one with a broken, corrupt health care system plagued by competing interests, misinformation, and a growing inability to distinguish real medicine from marketing, faith and science are equally critical.

Science involves the pursuit of universal truth; as a necessarily iterative process, its assertions are transient. And the media capitalizes on its ephemeral nature, inundating us with provocative headlines on a daily basis. Wine is good for you; wine is bad for you.Saturated fats kill; maybe they aren’t so badColonoscopy saves lives; here’s the story of a young man, his life cut short by a dastardly doctor—cause of death: colonoscopy. Patients face a never-ending flood of conflicting, inaccurate half-truths. Throw in a few misleading pharmaceutical ads, and a healthy distrust of all things medical is constantly evolving.

In contrast, faith is relatively immutable. The Bible, like the sacred texts of most major religions, has survived, largely unchanged, for hundreds of years, offering ancient insights on everything from stress management to dietary habits. Similarly, the caring advice of close friends and family members, those that have consistently proven their loyalty with sound, disinterested guidance, forms an impenetrable fortress of time-tested wisdom in each of our minds. And our own instincts, genetically coded beacons that have steered us clear of danger across millennia, stand guard within us throughout our lives.

Faith, then, in all of its forms and in its own way, can be every bit as useful as science at elucidating truth by tempering the expediency of any age with an easily accessible, albeit heuristic, frame of reference. For example, at one time the best available science concluded the earth was flat. Were those impelled to believe otherwise somehow ignorant? And prescribing some of the medications commonly in use just thirty years ago would now be tantamount to malpractice, many of them proven ineffective or even harmful. Were patients that chose to not take those drugs stupid? Or did their intuition save their lives?

The scientifically devout often dismiss faith as little more than a way for weak-minded individuals to seek comfort in false prophets that exploit their ignorance. That cynical depiction of faith, though, more accurately describes our current health care system. What we now consider medical “evidence” is often laughable. Marginally outperforming a placebo under contrived, unrealistic conditions hardly rises to the level of “proof.” In fact, if theologians were held to that same, low standard, it would be simple for them to unequivocally “prove” the existence of God — one skillfully designed clinical trial is all it would take.

And yet we regularly endorse the safety and efficacy of the invisible, infinitesimally small molecules in new pharmaceutical drugs, often despite having no idea how they actually exert their biochemical effects or what impact their long-term use will have on someone’s health. And we make countless recommendations based on fatally flawed studies, studies that, at best, are only marginally applicable to individual patients and, at worst, are biased by the financial or political interests of the entities conducting them. When physicians engage in these activities are they not, in fact, false prophets, shills for those that profit from pseudoscience offering somatic salvation?

Can anyone that respects real science support the widespread use of statins as a primary prevention measure against cardiovascular disease? Can any honest physician explain the rising prevalence of ADHD, or the designation of childhood daydreaming as a pathological process, in scientifically valid terms? What about the all-too-common practice of prescribing antibiotics for viral illnesses, Viagra for perfectly functioning genitals, or testosterone for those seeking eternal youth? Why is it that, in some hospitals, virtually all inpatients are placed on anticoagulants and proton-pump inhibitors, almost as a matter of course? Are these the result of good science or marketing-based medicine?

But what does all this have to do with vaccines? After all, the evidence in favor of routine vaccination is comparatively strong. Yet that is precisely the problem faced by any profession that has “cried wolf” one too many times. For example, many people exhibit a general distrust of car mechanics. They fear they’ll be fleeced, that costly, unnecessary maintenance will be performed, that their car won’t be properly repaired. And people that feel this way rarely say, “I don’t trust mechanics when it comes to transmission work, but they’re great at fixing fuel injection problems.”

Similarly, people skeptical of the medical profession generally find it hard to trust any of its advice, except when it offers immediate pain relief or disarms an imminent threat to life — much like the need for regular automotive maintenance can be easily ignored, but a car that won’t start is grudgingly towed to the local mechanic. And as long as the profession continues to do a poor job of distinguishing real science from highfalutin, profit-driven drivel, it has no moral grounds on which to condemn faith, a force that, in all of its forms, challenges and protects, one that arises from what is most human within us.

I am a man of science, but I am also a man of faith. And I sincerely believe the two will one day meet to yield a singular, universal truth that is both scientifically valid and spiritually fulfilling. Until then, however, I would urge all patients to embrace their faith, to heed the advice of close friends and family members, to trust their own intuition, education, and research, now more than ever, because the sad truth is that our health care system does not always have their best interests in mind. Despite that unfortunate reality, however, I would also urge them to see vaccination for the relatively safe and effective intervention that it is. Remember, even a broken clock is right twice a day.

Luis Collar is a physician who blogs at Sapphire Equinox. He is the author of A Quiet Death.

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  • http://www.amerechristian.com/ Ron Smith

    Hi, Luis.

    Good article. I would point out that true science is not what many mean when thy describe science. I pointed this out in my new book “A Mere Christian” and it so very true in medicine.

    Many scientists use that word ‘science’ like a club hoping to pummel those unbelieving serfs around them into conformed submission.

    To use ‘science’ in that way is to convert one’s self to the religion of science. As an understanding of that take the evolution debate. Most scientist feel that it is settled ‘science’ but yet make some very large assumptions. I went through the process what would have to happen for an amoeba to come out of the primordial soup in an article here:

    http://www.amerechristian.com/2014/05/nudging-the-evolutionary-argument/

    My thoughts after reading your article conclude that both patients and physicians distrust one another when it comes to faith, and each because of personal convictions about their own faith.

    Just so no one thing wrongly of what I’m saying, I am a strong proponent of vaccines. I’m also a Christian with an appreciation for a patient’s faith. Each are equally valid considerations, though each can be equally wrong.

    Take for example the Rotavirus vaccine. Vaccines are mostly considered safe by physicians across the board. But the first Rotavirus had devastating consequences for some children who had to have barium reductions or even surgery to reduce an intussusception. I rarely hear many discuss the negatives of some vaccines.

    Thirty one years ago, I would see about 4 to 6 children a month with temperatures over 102.5 and extreme irritability for three hours, all within the first day of their DTP vaccine. The manufacturing process improved so that when the Hib vaccine was introduced it had essentially little side effect. But it did reduce Hemophilus influenza meningitis dramatically from the two a year I used to manage to none (zero) that I have seen since.

    Patients and physicians need to be balanced of course and respectful of each other. But then that requires an assault on pride for each of those groups.

    Warmest regards,

    Ron Smith, MD
    www (adot) ronsmithmd (adot) com

    • Luis Collar, M.D.

      Thanks, Dr. S. As always, I appreciate the thoughtful comments.

      I agree that science and faith (all faith, not just religious faith but also intuition and other related concepts) are often pitted against each other unnecessarily. The fact is that both play a critical role in our lives, and both can lead to “correct” or “incorrect” conclusions. This is because both are imperfect processes that evolve over time, that mature as core assumptions are challenged.

      I think the danger, then, is to assume that medicine is always right, that anyone that chooses to believe otherwise (either because of faith, advice, personal experience, weak “evidence,” etc…) is, by definition, wrong and somehow ignorant. I still believe the role of a physician is to counsel and advise, not to mock, dismiss, ignore, or assume a position of intellectual superiority, even when he or she is understandably frustrated by a lack of patient adherence. Physicians don’t know everything and “the best available science” isn’t always quite right; admitting that can alleviate considerable stress for both doctors and patients.

    • rbthe4th2

      It is good to meet a brother in Him, Dr. Smith. :)

  • SteveCaley

    I enjoy the phrase, “And that sort of intellectual vanity also devalues one of our country’s richest traditions: faith.”

    Vanity is a wonderful word, hardly used these days, probably because if it’s understood properly, it’s everywhere. Not quite arrogance – not quite self assurance.

    Nietzsche is supposed to have said, “How poor the human mind would be without vanity! It resembles a well stocked and ever renewed ware-emporium that attracts buyers of every class: they can find almost everything, have almost everything, provided they bring with them the right kind of money — admiration.”
    We are not everything. We don’t know everything. We don’t live forever. It is fine for people to puzzle this out on their own and come up with different concepts of truth.

    • Luis Collar, M.D.

      Well said. Thanks for contributing.

      • querywoman

        Dr. Luis and Dr. Steve, you are my two best faves of the doctors currently posting here.
        You are not afraid to admit your limitations.
        I just read a story of a man who supposedly died because he was on the VA’s, “postponement,” list. He was pretty sick. He probably should have been sooner, but he was on his way out.|
        I don’t expect to live forever.

  • DoubtfulGuest

    “Faith, whether disguised as a trusted colleague’s advice, previous patient anecdotes, or even visceral “whispers,” accompanies all physicians into the exam room.” Just a note of caution: I had a progressive neurological disease missed for years, and was accused of malingering based on no evidence, because of “trusted colleague’s advice” and “visceral whispers”.

    A specialist had a “visceral whisper” that I wasn’t honest and he took an instant dislike to me. Wrote a five-page letter to my referring physician essentially saying that I was a crock. The referring physician dropped me after that. It took four more years to get the correct diagnosis from different doctors. The doctor who heard the whisper later died of a disease that causes the brain to whisper incorrectly. My referring physician had gone right along with this senior colleague, who he’d never met, never questioning the length and repetition of that five-page letter, never questioning the other doctor’s whispers that went against all objective evidence that I was quite ill. So, if people would be careful with this “doctor’s intuition” business, I’d really appreciate it. Thanks.

    • Luis Collar, M.D.

      Hi DG… Very sorry to hear about your ordeal. I hope you were able to resolve the issue or at least get the care you need.

      Though I see your point, remember that the opposite is also true. That is, intuition can lead a physician astray but so can relying exclusively on data or research of limited applicability to a particular patient. In other words, a physician can arrive at the wrong conclusion because of faulty intuition (or sometimes, more accurately, bias). But he or she could also take a look at your presenting symptoms, find that it doesn’t fit any textbook presentation (or at least any he or she knows of), and dismiss your concerns if that is all he or she relies on.

      The key, in both cases, is to respect patients, listen, and use good judgment to combine both data and anecdotal experience to hopefully arrive at the correct conclusions. My point wasn’t so much that intuition is any better than evidence. But it is absolutely true that, even when they aren’t aware of it, these things affect physicians’ approach to patients and their illnesses.

      • DoubtfulGuest

        Agree, thanks, Dr. Collar. I guess my problem is I haven’t been able to resolve it. It seems physicians’ hunches, guesses, feelings and impressions are allowed to trump objective signs when they serve a physician’s needs. No matter how bizarre the circumstances, there’s no relief for a patient who ends up on a doctor’s bad side. The “intuition errors” go unexamined. That a doctor “thought so” or “felt that way” has a lot of power. When used properly like you describe, if I understand correctly, doctors simply decide to take more time to gather the objective evidence they need to back up their intuition. When it goes wrong, the hunch can be the final thing. The patient goes without needed care or has to start from scratch with new doctors.

        My other issue is to ask the docs here to use their own judgment when assessing other doctors’ opinions, even ones with seniority or more experience. If something seems a bit odd, please pay attention to that feeling and ask for more factual information, too. Yes, doctors mostly use intuition to help patients. I think sometimes they pick up on a vaguely ill appearance in a patient or they just feel the symptom reports are genuine. I definitely agree that more self-awareness of the intuition side of things leads to sharper judgment.

        • rbthe4th2

          Agreed and your first sentance said a mouthful.

    • querywoman

      Sad! I have had similar experiences. When I had Kaiser in Texas, I could not get away from what the first bozo doctor wrote about me.
      Many of my unusual symptoms went away when I went all the way into diabetes and got the right treatments, eventually.
      I have been taken more seriously since becoming diabetic.
      Glad you finally got the right answers.

    • rbthe4th2

      I’m sorry for that DG. As someone who has suffered in the same way, and will pay the price for that physician, I understand you well.

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