Vatican + doctors = bad medicine

Shady goings on at the Vatican with the canonisation of Mary MacKillop. Two cases of remission from cancer and TADA!!!!! a new saint!!!. This nonsense is lent ostensible gravitas by the commission of doctors. The Medical Committee of the Congregation for the Causes of Saints is responsible for establishing whether a genuine medical miracle has occurred (quick recovery from a laminectomy in the case of Cardinal Newman's beatification). Now, all studies thus done have shown no benefit from intercessory prayer. Thus, any doctor who testifies on any Vatican medical committee ignores evidence and invokes a supernatural explanation. That's not being a doctor, that's bearing witness. They might as well ask anyone with a belief in supernaturalism. If a doctor is giving evidence about something to which his training is irrelevant, then a committee of ice-cream salesmen could do as good a job.

Most of these miraculous justifications state that at least one doctor said "the patient would never walk again", or "had 6 months to live". No doctor I've ever known has never had the confidence in their skills to make a definite prognosis like that (and I've known some pretty confident consultants). That's the way doctors break bad news in Hollywood films and bad daytime TV dramas. Patients might unfortunately hear it that way, and people anxious to prove a miracle might make it up, but doctors don't say it. Doctors say things like "his spinal cord is almost completely severed at T7-T8 level. It's extremely unlikely he'll ever get sufficient motor function back to be independent of a wheelchair". Or "On average, people with small-cell lung cancer survive 6 months". Prognostication is something EVERY doctor has doubts about his ability to perform, as each one knows several patients who defy the odds (whether they pray to Mother McKinnon or not). I've seen diabetic patients whose blood sugars should have killed them years ago. I contact their GP, not the Vatican.

Adele Horin (thanks Pharyngula) has another splendid angle on the whole affair here.

At the time Mary MacKillop answered the prayers of a woman dying of leukaemia, there was a lot of static in the air. In China 43 million people were dying of starvation in one of the world's worst famines. Thirty years later in the 1990s, when MacKillop answered the prayers of a woman dying of lung cancer, 3.8 million were dying in the Congo wars, 800,000 in the Rwanda genocide, a quarter of a million in the Yugoslav wars.

Very good of MacKillop's ghost to hear and answer the prayers of two Australians amongst such carnage.

VP of Center for Intelligent Design in Glasgow is a consultant colorectal surgeon!

David Galloway is a consultant colorectal surgeon working at Gartnavel General Hospital and Western Infirmary, Glasgow. He is also vice-president of the new Centre for Intelligent Design in Glasgow. Yep - a surgeon holding office in an organisation that gets into all sorts of difficulties with evolutionary concepts such as development of bacterial resistance to antibiotics.

A member of the Lennox Evangelical Church, Dumbarton, his medical career has not been visibly hitherto encumbered by the cognitive dissonance involved in reconciling Eve's creation from Adam's rib (or Mary's virginity) with his scientific training. Indeed, he is current vice president of the Royal College of Physicians and Surgeons of Glasgow. I would think that august institution is particularly proud of his new affiliation and its rather unsubtle attempt to get intelligent design teaching into schools north of the border (thankfully, down here the government has clarified its position on that sort of nonsense). However, the centre's leaders have rather given the game away by talking about their fundamentalist Christian beliefs rather than the supposedly scientific basis of ID. Oopsy.

Francis Collins betrays the rational basis of his profession

With a distinguished research career, and having directed the National Center for Human Genome Research and latterly the National Institutes for Health, Francis Collins is one of the most accomplished and important doctors of his generation. But that doesn't make him a good example to other doctors.



Collins is an evangelical Christian, but he's not a bigot else I doubt if Christopher Hitchens would have suffered his friendship for long. Of greater concern is that Collins has written in the Washington Post about how he's praying for Hitchens ('Praying for my friend Christopher Hitchens'). Praying for someone who believes his legacy will be to have "made a stand for those who are trying to hold reason and science against superstition", and who has requested people do not pray for him seems pretty disrespectful (that is, after all, why most Christians are participating in the 'Pray for Christopher Hitchens' day). But doing it without a shred of dignity by putting one's piety on display for the purposes of self-promotion in the pages of a national newspaper is doubly so.

In any case, Collins is the sort of apologist who finds no clash between science and religion, believing that his god is outside the normal universal terms of reference and therefore impervious to scientific investigation. (Jerry Coyne begs to differ here). In other words, so as not to fall foul of the 'God of The Gaps' (the gaps eventually yielding to scientific investigation and thus progressively squeezing the hiding places for the irrationality of faith), by a sleight of hand he's invented in his own mind a chasm rather than a gap. But to ensure that even this chasm can't be bridged by science, he's importantly declared that this chasm has only one side. And to think that Thomas Aquinas went to all that bother with natural theology.

I've alluded to various psychological research that shows how of the cognitive biases that allow intelligent doctors to believe nonsense, but it is astonishing what otherwise reasonable people can do in the service of their beliefs. Collins' acheivements cannot excuse the poor example he sets for the medical and clinical science. Don't worry about an evidence-base if it doesn't suit your purposes. Just make something up. Preferenably something that other people can't call you on.

And whilst you're there, why not take the opportunity to do a bit of proselytising by writing about it in the Washington Post?

Royal College of Psychiatrists spirituality group chairman thinks Demons can cause mental disorder

In 1976, two Bavarian priests were convicted of negligent homicide in the case of 23-year-old Anneliese Michel, an epileptic who died after her treatment was discontinued in favor of exorcism.

It's nice to know that such potential is still alive and well in the UK. I previously blogged about an article appearing on the Christian Medical Fellowship's website advocating that doctors should consider demonic possession as a differential diagnosis in mental disorder. It was picked up on by Iain Brassington at the excellent Journal of Medical Ethics blog.

At the time I didn't realise that the author held office. The article was written by Prof. Chris Cook, who is now the Chairman of The Royal College of Psychiatrists' Spirituality and Psychiatry Special Interest Group. He's a consultant psychiatrist who still works for Tees, Esk & Wear Valleys NHS Foundation Trust. Is it only mental disorder, or are other disorders caused by demons, such as hypertension or diabetes? It's one thing when society stigmatises mentally disordered persons, but quite another when members of the medical profession do so.

http://www.dur.ac.uk/theology.religion/staff/?username=dth0ccc
http://www.rcpsych.ac.uk/rollofhonour/specialinterestgroups/spirituality/aboutus/executivecommittee.aspx

Hospital chaplains facing the axe

The National Secular Society has an article on swingeing cuts facing hospital chaplaincies.

The chaplains have always attempted to justify themselves by saying they provide an important source of spiritual comfort to the religious (of all denominations) and non-religious alike. The notion that those of other religions benefit from the pastoral services of Christian chaplains is of course nonsense, a bit like saying that the provision of free petrol benefits those with diesel cars (or, in the case of atheists, no car at all). Try to imagine Christians utilising pastoral services provided by Scientologists (and proposing that these services are paid for by taxpayers!). Those sharing the beliefs of the chaplain are privileged by this spending.

And what a lot of spending it is. Many people I talk to are amazed that hospital chaplains are funded by the NHS. In 2009, figures obtained under freedom of information requests revealed the total annual cost of chaplaincy services to the NHS in Great Britain to be upward of £35million.

The Unite union for healthcare workers is investigating whether chaplains are being targeted 'disproportionately' as in Nottingham, where four out of five chaplains have been cut. If the alternative is to cut doctors and nurses, whose services are needed by everyone in hospital irrespective of creed, I think this could be a case of most people agreeing where the axe should fall in the NHS.

Now, that defence department spending review: shall we cut Trident or army chaplains? (actually...I...er...best not get started).

70 children dead from religious opposition to vaccination

As if the children of that country have't got enough problems, Pharyngula notes that a measles outbreak in Zimbabwe has killed at least seventy children over the last two weeks. The outbreaks are mainly in apostolic religious sects which combine Christian Fundamentalism with traditional African religious practices, with children being treated with holy water and prayer. They are strictly opposed to vaccination. But I suppose at least they can claim poor education, a country ravaged by poverty and corruption, and colonial religious indoctrination. Unlike other supernaturalists such as the adult model Jenny McCarthy, the actor Jim Carrey, or sundry Christian Science sects who hold similar beliefs with similarly tragic consequences.

Religious doctors more likely to flout professional guidelines on end of life care

A study finds that doctors who are religious are less likely to discuss options about end-of-life care than non-religious doctors (specifically, options relating to deep sedation and withdrawal of treatment that may be expected or partly intended to end life). These findings, reported in all the major media yesterday, suggest that religious doctors break GMC guidance (the UK General Medical Council) which states that end-of-life care issues such as withdrawal of feeding, 'do not resusitate' orders, and treatment decisions that may hasten death should be discussed with patients who have a terminal illness at the earliest appropriate opportunity.

Darwin used to extol the virtues of writing down any and every thought that might refute one's favoured hypotheses, and consider them at length. The results of this study agree with how I think religious doctors are likely to think and act. So, in case I am blindly accepting empirical data with preconceived notions, let's try to consider if the papers conclusions could be wrong: that it's possible that religious physicians are NOT more likely to break GMC guidance on end of life care. Possible methodological flaws that make this more likely include:

1) The doctors to whom the questionnaires were sent are not representative of their profession, or faiths.
2) The doctors who returned questionnaires represent a biased sample.
3) The doctors who returned questionnaires incorrectly recalled (or deliberately mis-stated) how they handled the cases of their last patient who died.

The paper, by Prof. Clive Seale at London University and published in The Journal of Medical Ethics, considers each of these possibilities. With regards to 1), the sample of doctors was selected to include disproportionate numbers of palliative care specialists, geratologists, and neurologists, whom are involved in complex end-of-life cases (e.g. in the case of neurologists, multiple sclerosis, motor neurone disease). The sample is thus biased, but biased in order to better elicit a good answer to the question in hand. With regards to 2), 42.1% of the 373 doctors sent questionnaires replied, and the proportion was as high as 67.3% for the palliative care specialists. This seems a relatively decent response rate for a postal survey to busy professionals. Furthermore, the author presents data to show that responders were not significantly different in attitudes from non-responders (whose attitudes were elicited by follow-up in another study).

3) is likely to be a far more valid criticism of the study, but it is also a problem with any attitudinal/self-report study. Although the questionnaire was anonymous, if I were a devotee of a religion which held as a core tenet that life should be preserved at all cost (even if the patient's suffering is increased as a result of my belief), I would certainly want to report that I never consider treatment that might shorten patients' lives (in case my deity took note of my response). And if I were an atheist doctor, I might want to show my support for the doctrine of double effect by answering that I consider terminal sedation a great way to avoid unnecessary suffering, even (but no because) it hastens death (the study also found that non-religious doctors are approximately twice as likely to report having taken treatment decisions that might be expected or partly intended to hasten death).

The British Medical Association said in response to the study: "Decisions about end-of-life care need to be taken on the basis of an assessment of the individual patient's circumstances - incorporating discussions with the patient and close family members where possible and appropriate. The religious beliefs of doctors should not be allowed to influence objective, patient-centred decision-making. End-of-life decisions must always be made in the best interests of patients."

Likewise, Dr Ann McPherson, the Oxford academic, GP, and patron of the charity 'Dignity in Dying' added that "The fact that some doctors are not discussing possible options at the end of life with their patients on account of their religious beliefs is deeply troubling". And, in spite of being an argumentum ad verecundiam, as a recipient of a CBE for her lifetime campaigning for patient choice, as well as being a terminally ill patient herself, Dr. McPherson's views might be thought somewhat more weighty than the author of this blog.

Unfortunately for those such as Dr. McPherson who believe that patients have a right to be involved in decision-making about their treatment, where ethical guidelines clash with religious beliefs, doctors appear to prefer the codes of their ancestral belief systems instead of the latest GMC guidelines. Whilst quality of end-of-life care is ranked higher in Britain than any other country, the moral of the story is, as soon as you are diagnosed as terminally ill, ask whether your doctor is religious. Or get a tattoo.