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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