The Most Potential

Abortion by definition takes life at its youngest and removes the most years of potential life, about thirty times more than all the other causes of pediatric deaths under one year of age. Pastors, physicians, or pro-life counselors who try to impart reverence for life, even if they succeed only 3% of the time, will save as many years of potential life as would the total eradication of all deaths during the first year of life!


Excerpts from Physician and Pastor: Co-Laborers

Spiritual Roots

To gently confront a young, single woman who is requesting birth control pills for reasons of contraception (marriage not imminent) and see the reaction change from puzzlement to astonishment and finally to admitted concern for her errant "lifestyle" [that marvelous euphemism now for sin] is rewarding. Rather than being morally uninvolved or professionally detached, it seems essential to offer to get nearer to the root of such problems. The root is spiritual. Rather than acquiescing to the blunted sense of sin which our culture inculcates, it is rewarding to sharpen it. The trick is to do it gently, by example and by the Word, allowing the Holy Spirit to do any convicting that is to be done.


Excerpt from a private letter

How the Government Killed the Medical Profession

Government interventions over the past four decades have yielded a cascade of perverse incentives, bureaucratic diktats, and economic pressures that together are forcing doctors to sacrifice their independent professional medical judgment, and their integrity. The consequence is clear: Many doctors from my generation are exiting the field. Others are seeing their private practices threatened with bankruptcy, or are giving up their autonomy for the life of a shift-working hospital employee. Governments and hospital administrators hold all the power, while doctors—and worse still, patients—hold none.

-- An excerpt from "How the Government Killed the Medical Profession" by Jeffrey A. Singer, an article Dr. Terrell would have liked.

Read the rest of the article here.

The Privilege of Self-Medication

We are set to think of self-medication as bad, because we see so many problems with it. We should pause and consider a couple of other things, however.

First, the bad outcomes we see do not necessarily mean that the privilege of self-medication should be restricted. To restrict that privilege means that we think of ourselves as more than advisers and assistants. It means that we think of ourselves as controlling authorities. Where in Scripture has God authorized us as having any controlling authority over our patients?

Second, we have no good denominator for the dangers of self-medication. That is, we see those who have problems, but we are not nearly as aware of those who do not have problems. Every treatment has a certain failure rate. That is, we have a numerator of failures sitting over a denominator of all treatments. Unless we know the denominator we cannot know the fraction. If we do not know the fraction, we cannot know the rate. If we do not know failure rates, complication rates, and success rates, we are presumptuous to deny people by law the ability to decide for themselves.

We tend in medicine to practice on the numerator kind of information. We make decisions based on partial information. Patients need to be able to "vote with their feet." It is a check on us "experts." We, too, have fallen natures, with pride and desires for power and money. We want to have our way.


Excerpt from "Pharmacy and Medical Interventions"

Extending Life Expectancy?

I don’t think it’s been shown that the medical profession has had anything positive to do with extended life expectancies in the United States. It’s a definitional matter. It’s an epistemological matter -- how do you know what you know. You start with presuppositions about your view of a human being: a human being is a person conceived. The medical profession, alone, is accountable for a decrease in average life expectancy. From around fifty years around the turn of the century in this country, to around forty-five years today -- probably having passed through a time of greater life expectancy in the mid-forties to early sixties, after which abortion became commonplace. Definitional issues aside, for those people who were allowed to make it to birth, there has been a very substantial increase in life expectancy, which might in part be due to some of the things we do in medicine. It was just done at too high a cost, as we took the resources of those who were not allowed to live and diverted them into many things, one of which was vast medical establishment that now exists.


Excerpt from an interview with Dr. Terrell

The Mistake of Medical Licensure

[Medical licensure] is a mistake. It is only about a hundred and three years old where I live, and similarly, about a hundred years old in other states. So its a very new idea when placed against the backdrop of medicine as a whole. As usual, it was promoted with the idea of the public good. But if you look at it, as usual, it was the physicians who wanted to remove certain kinds of competition that they had disdain for. It is one of the reason for higher costs. It is one of the reasons that orthodoxy has been able to be so militant and stamp out of so much of unconventional treatment by calling it quackery -- and I indeed believe that there is much quackery out there -- and pushing it off the playing field without being able to show that what they do is all that bad, or all that different from what we do. It’s a form of state-granted monopoly which Caesar has granted to certain privileged people such as ourselves.

This authority really resides in God in the family, not in the “experts.” We are tyrannized by the experts. The profession as a whole is a tyranny of experts. Physicians are able to enact their own agenda without sufficient proof that what they do is all that splendid. Licensure is a mistake and it is one that I expect will be remedied, perhaps within my lifetime. It is very radical to propose that licensure is wrong, but there are strong pragmatic reasons for it. In my own state we are seeing an expansion of who is able to do certain things -- there are nurse practitioners who can now prescribe, chiropractors are moving in on the medical turf, and there are physician assistants of various sorts. I am in favor of that, basically, because it is expanding the number of people who are able to do what I do without being arrested for it. And the ultimate end is that after awhile so many people will be empowered to do so many things, that after a while licensure will simply die, and will be of no use to those who promoted it for personal gain.


Excerpt from an interview with Dr. Terrell

Viewing the Broader Outcome

The means [in medicine] are very impressive. But the outcomes sometimes aren’t. Part of that is nature of reductionistic science itself. When we narrow our focus of view to, “Did the patience die of heart disease after this bypass surgery?”, you may get one set of figures that looks really good. But when you look at all causes of mortality after a treatment, you may find that others may increase to balance out the benefit that you got. But the person in the profession who is focusing on the outcome in their little particular part of the world of medicine didn’t choose to look at that because it was outside their field of view. As a generalist, I am one of those who are supposed to called upon to look at a wider array of potential outcomes. When you look at that, you find that medicine, even in some of our cherished areas, has fallen short.


Excerpt from an interview with Dr. Terrell

Facts vs. Wisdom

Doctors are concerned about keeping up with the literature, which is absurd on its face. There are millions of articles published in English alone relevant to medicine every year. If you are so aware that you could hone them down to one percent of what is published, you would have a daily reading load so heavy that you could never keep up. We have confused data with understanding, and the acquisition of massed of so called facts with wisdom. It is particularly telling that the fear of the Lord is the beginning of wisdom. Medical schools never mention the Lord in any positive contexts, whatever. We have grown away from the wisdom that was, perhaps, once there in medicine. Once we dropped the integrating capacity of Scripture, the data no longer makes any sense.


Excerpt from an interview with Dr. Terrell

Presuppositional Medicine

Medicine itself is an empirical endeavor; we look at how things are. We look at the natural man. Yet medicine cannot tell us how things should be. Medicine is empirical in a lot of ways -- in its application -- but in its formation and its fundaments it is presuppositional. And the only proper presuppositions are those of Scripture, which are best stated in the Westminster Confession of Faith and the Larger and Shorter Catechisms, or documents like that, such as the Heidelberg Catechism.


Excerpt from an interview with Dr. Terrell

Tyranny of the Expert

Christian teaching for the denominator population is a powerful force for health. If Churches were more obedient, it would be an even more powerful force. The medical profession needs the input from the Church to clean up its act, to put its powerful tools into the right perspective, to make sure that our methods are harnessed to the right questions. While science pretends to abhor the method of authority, and tells tales about the bad old days in which medicine kow-towed to authorities who did not do experiments, we still live in an authoritarian system. The authorities tell us not only that the only method of any real use is the "scientific method," they also insist on casting the questions in materialistic terms only, throwing revelational epistemology off the playing field.

They are applying their epistemology where it does not legitimately apply, to normative issues. We have a "tyranny of the expert," who knows much more than we do, yet who does not see that the depth of vision has been gained at the substantial cost of a breadth of vision. The Church can restore the breadth of view to illness and health, can reclaim the validity of the method of revelation, and pitch out the method of natural science from its stolen territory.

Medicine has become somewhat like the man who knows the cost of everything and the value of nothing. There is a need for a generalist -- not speaking here of a medical generalist, which I am, though that is true, -- but of someone who has the whole person in view, -- in the context of the family, church and society, as well as a time span that extends beyond a six year follow-up study. We need someone to have a view all the way to the deathbed and to eternity beyond. Medicine demands now an illegitimate thing of its practitioners -- that we give up our general office of believer and priest in order to become a body mechanic. The body mechanic image is a very dangerous one for medicine.


Excerpts from Physician and Pastor: Co-Laborers

The Need for Pastoral Counseling

Physicians deal mainly with sick numerators, persons who have presented their bodies a living sacrifice for us -- our community is the sick. There have been efforts within medicine to deal with the whole community, and public health medicine is its best expression, but for most practicing physicians, the community is more or less out of reach. As far as sickness is concerned churches deal with denominators -- both the sick and the well within the community of faith. The Church also deals with the “fields white unto harvest,” the pagans, both sick and the well in those fields. While medicine has incorrectly restricted itself to empirical, evidential data, it has also drawn its data too often from numerators only. The Church has the opportunity to see these sick numerators in the illuminating context of their spiritual denominators -- how sickness relates to spiritual condition. Furthermore, medicine has cut off revelational data -- input from the Bible. Pastoral counseling can restore this missing feature of revelation to its powerful role in maintaining and regaining health.


Excerpts from Physician and Pastor: Co-Laborers

Limitations on the Disease Model

The medical profession's perception has become so limited to the theoretical constructs known as “disease entities,” by which is meant only the physical causes and manifestations of disease, that it is unable and unwilling to see that mankind is a living, breathing spirit folded into a body. Pastoral counseling offers one major avenue to instruct the medical profession and other onlookers, as it instructs the direct recipients.

Of the many possible examples, one of my favorites is a two-page ad for the anti-viral drug Zovirax appearing in many medical journals. Page one of the ad shows a downcast young woman seated alone in a sidewalk cafe lamenting that genital herpes has put her into “solitary confinement.” Page two shows the same girl smiling and in the convivial company of another young woman and two very nice-looking young men. The girl was in “solitary confinement” only in that she could not fornicate. Better living through chemistry “solves” the problem by enabling her to fornicate somewhat more freely. The ad treats of the issue of genital herpes as though it is merely a matter of viruses, their DNA structure, and chemically substituting a different base in the thymine, guanine, etc., pairs. The acceleration of this kind of narrow thinking is traceable to about 1960. Since that time, all of our venereal diseases have increased in frequency, greatly, with the addition of new diseases such as AIDS.


Excerpts from Physician and Pastor: Co-Laborers

Medicine Without the Word

Matthew 4:4 "...It is written, 'Man shall not live by bread alone, but by every word that proceeds from the mouth of God."

Medicine is sustenance of the same sort (though of lesser necessity) as is bread. To try to live by medicine without the Word of God is destined for frustration and failure.

Saving Life

Bernard Cohen produced what he calls a “catalog of risks” [found here] in which he tries to put the various risks life has to offer into order according to their “riskiness.” He uses the method of years of potential life lost which he terms “lost life expectancy.” The results of his work are eye-opening, revealing the narrow mindset medicine has developed. For example, a person who lives an alcoholic lifestyle on the average lops 4 thousand days (about 11 years) off of his life. If a counselor were successful only 5% of the time in seeing an alcoholic changed, he would save as many years of life as would the medical profession if the medical profession were able to save all burn victims, or all poisoning victims. If the counseling were an effective instrument in getting people out of poverty by means of getting them back to work, and was effective only 3% of the time, the counseling would save as many years of potential life as would be saved by eliminating all deaths by motor vehicle accidents if the relationship that poverty has with mortality is causal.


Excerpts from Physician and Pastor: Co-Laborers

Unhealthy Day Care

[T]he widespread use of group day care facilities needs to be challenged. While it seems reasonable that a family may delegate at times portions of its child care duties to others, the family retains the responsibility for what occurs. Day care just cannot be as healthy as a biblical family. A toddler enrolled in day care can expect to be bitten by another child within an average of 73 days. While siblings within homes also bite one another, the toddler at home is not going to be surrounded by 20 other toddlers who are in the prime "biting age." One mother just cannot give birth to that many children in a short period of time. It requires collecting them from many households.

The risk of infectious disease in day care is two to four times greater than for children cared for at home. This includes gastrointestinal infections, which are also carried to other family members at home. Otitis media also is increased in day care children.

You would expect such information would impel reasonable people toward a view that small children, if possible, are better cared for in homes than in group day care, and that policies to support that end would be the best ones. Instead, as example of the narrow way medicine has of conceiving of problems and their solutions, listen to the "answer" of the researchers of a major review of illness and day care, persons at the Bush Institute for Child and Family Policy at the University of North Carolina at Chapel Hill. "... government intervention is justified when a market fails to measure adequately the true costs or benefits of a given market transaction. ... It seems reasonable ... to recommend specific regulatory provisions ... regulations requiring parents to demonstrate that they have been following a schedule of health visits for their child, (such as that recommended by the American Academy of Pediatrics.)"

That government policies encouraging two-parent wage earner families built into the tax structure and otherwise is the problem is not even considered. That changing policies to reduce the demand for group day care is a better approach is ignored.


Excerpts from Physician and Pastor: Co-Laborers

A Fraction of the Picture

The prior probabilities of disease profoundly influence the decisions of the practitioner in making diagnostic decisions. Generalists look at subspecialists and are tempted to conclude that they are always seeking zebras. Subspecialists are tempted to look back at generalists and conclude that they are always missing things. Our denominator populations are different. Our error rates are not necessarily different…

Rather than pursue medical internecine warfare, consider that we in medicine as a whole have been turning to the entire population and telling it how it ought to function for health. The estimates of patient self-selection prior to seeking medical attention is probably an underestimation of the self-selection that takes place before any of us in medicine see the patient. Other studies estimate that physicians see patients in only 6% of all episodes of illness. Not only are we prone to be mechanistically disease-oriented, we see only a fraction of the whole picture!


Excerpts from Physician and Pastor: Co-Laborers

Ignoring Denominator Populations

Today, physicians initially learn about sickness from the sickest of the sick… “Tertiary care” hospitals collect the rarest of the rare. We have “zebra farms.”… Hospitals are remarkably efficient for displaying diseases in several stages of development or varying manifestations as well as for studying their response to treatments. On one ward may be collected all manner of cancer or infection or genetic diseases. The benefits we have enjoyed in medical understanding from such collections is not to be underestimated. However, along the way, these collections have helped us to ignore the denominator populations from which they were drawn, as well as the possibility of taxonomies based upon other features than bodily diseases.


Excerpts from Physician and Pastor: Co-Laborers

Forgetting Wisdom

We let ourselves be tyrannized by data, by information, and have forgotten wisdom. Good science requires good questions.


Excerpt from "Pharmacy and Medical Interventions"

Ignoring the Monster Inside

Science in medicine has become master instead of servant. We have viewed health and illness as an alien something that leaps upon our backs in the dark and fastens to our flesh. This model of sickness suggests that all that is needed is to peel the monster off of our outside. We can leave what we are inside, in our spirit, alone. Indeed, there is plenty of therapy which fits that model quite well. Yet, illness is more often substantially subjective.


Excerpt from "Pharmacy and Medical Interventions"

Sovereign God in Medicine

I have confidence... in a Provident God, who exerts His will in ways that are partly comprehensible to us by means of principles. Our present system [of medicine] in many ways is trying to overrule God. Have no fear. It won't.


Excerpt from "Pharmacy and Medical Interventions"