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

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"

Sin or Biochemistry?

Medical doctors and others are always incorrect when they state or infer that we are not responsible for our life, that we are morally victimized. When we are told that we are not responsible for our depression, that is usually not correct. Man is always responsible for how he manages his life, including management of a depression, and is usually responsible for the depression itself. Sometimes, however, it appears that an individual is not responsible for the occurrence of a depressed-feeling state. Some situations are just messy enough to preclude our ability to sort out precisely the contribution of faulty (sinful) life patterns and faulty biochemistry. A thorough counselor always can uncover sin in a counselee’s life. It does not follow that the depression is a specific result of that or any particular sin, nor that dealing with the sin will remove the depression…

Moreover, just because depression usually is related to sin, can we be sure that all depressions are and eschew biochemistry in principle?

The relationship of body and spirit is integral so that tracing the source of feelings and motivational states sometimes can be impossible. It is relatively easy for a physician to trace a depression to a medication being given for another problem. Stop administering the medicine and the depression remits. Experiences like this strongly encourage physicians to believe that chemicals are causative of depression and that the chemicals could be as easily produced by a defective body as introduced into the body by a defective treatment. Likewise, it may be relatively easy for a counselor to trace a depression to a specific pattern of sin and see the depression remit as the sin is handled biblically. An impression may be encouraged that depression is thus produced always. Since depression is not a biblical word, we must be cautious in adducing Scripture to address it. There certainly are passages in Scripture which seem to reflect clearly what we today term depression, but we are retrofitting modern terminology. Wherever He has provided it, God’s terminology is the best to use to describe our problems...

If I feel miserable, have lost my ‘get up and go,’ have little interest in socialization, have no appetite, and feel like weeping when there is no provocation to do so, someone is likely to suggest that I am depressed. Such a state could arise from the body, from sinful habits, or from both. In any case, I am responsible for how I manage this state. If I give in to my feelings and fail to meet my responsibilities because I don’t feel like it, I am managing my depression sinfully. If a counselor uncovers a pattern of sin that seems to relate to my situation, I should put off the pattern and put on God’s pattern. If a physician has good reason to believe that I am flawed biochemically, there is no necessary sin in trying chemicals to correct the putative flaw, provided I do not neglect the former avenues. The Christian counselor’s forte is to point out my duty to fulfill responsibilities irrespective of my feeling state and to detect sins that could have led to my depression. Physicians do foul up the situation by exclusively teaching biochemical causes of feeling state, leaving Christian counselors with some deprogramming to do.


An excerpt from "A Caution Against Overstating the Case"

Mechanisms vs. Empirical Information

We have a tendency to substitute the mechanisms we have learned for outcome data. Pharmaceutical detail people major in mechanisms.

Pharmaceutical rep.: “This new medicine – Lipid-lo – scours atheromas at their base, substituting a slick, non-stick Teflon layer while the displaced lipids are carried by the ultra low density lipoproteins to the liver, where they are recycled along with aluminum cans into bone matrix that reduces osteoporosis.”

Doctor: “If my patients take Lipid-lo, is there evidence that their all-cause mortality or morbidity will fall?”

Pharmaceutical rep.: “This study in Stockholm last year, where they've used Lipid-lo for 1000 years, shows that middle-aged men had 22% fewer cardiac events than a control group that did not take the drug.”

Doctor: “I said all-cause. Did the Lipid-lo group have more hepatitis, or cataracts, or renal stones, or such?”

Pharmaceutical rep.: “I have another study here from Ohio in which the cardiac output during acute M.I.'s fell 33% less in the treated group than in the untreated group.”

Doctor: “Wonderful! But, did the treated group on the whole live better or live longer than the untreated group?”

Pharmaceutical rep: “It comes in convenient dose form shaped like a pretzel. See, you can break it in several points to get the right dose without having to switch to a new prescription.”

It's as if we were talking past each other. Mechanism is offered in place of evidence of outcome. Mechanisms are wonderful mnemonic devices, but things that stand to reason do not always stand to evidence.

What has this to do with making ethical decisions? When communicating with our patients, adding our unique input, we should as often as possible speak in terms of net outcome as based upon evidence. In medicine we are prone to focus on numerators.


Excerpt from "Counseling Persons with Questions on Medical Ethics"