Monday, November 23, 2009

"Spirituality and medicine" - some thoughts (and an anecdote for good measure)

Recently, a group called the "World Christian Doctors Network" (WCDN) organised what seems to have been a pretty "serious" event attended by over 500 medical professionals - the 6th "International medical conference" (this can't actually only be the 6th medical conference ever ... but anyway ...) in order to discuss "Spirituality and medicine". The point of the event seems to have been to allow Christian doctors to get together and "share" anecdotes about instances of "divine healing" of their patients.
Perhaps they wouldn't put it exactly that way (i.e. my scare quotes) themselves - in their idiom, the aim of the conference was to give Christian doctors a platform where they could "objectively confirm and examine instances of 'healing by the power of God'".
(Note : the WCDN looks shady, but the stated aim of their conference is as good an example as any for my purposes here)

Now, I have absolutely no problem with a doctor being religious. Really, as long as she or he is competent within the context of the doctor patient relationship, that's all good with me. However, as soon as a doctor (and I mean real medical professionals here, not homeopaths and chiropractors) starts attributing spontaneous recovery to the power of God, then it's another story altogether.

The problem is that it almost certainly wasn't God's intervention that "healed" the patient. For every single one of these "miracle" cases we can be sure that there is some rational, scientific explanation for it. But isn't this is some scientistic hand waving on my part, I hear you say? I don't think so, and I'm actually making a stronger claim than this anyway, so lets assume, for the sake of argument that there is no possible way that we could ever explain a patients spontaneous recovery, surely this must count as a miracle?

Not at all, it should never be an option - for a doctor, at least - to declare a recovery a "miracle", even if the explanation lies beyond the reach of our current best, or even future best, scientific theories and methods. A doctor declaring a patients recovery a "miracle" is always a profound failure on their part as a doctor.
This is because even if it were the case that we would never find a reasonable explanation for the patients recovery, the notion that all diseases and cures are, ultimately, amenable to scientific explanation should be a regulative ideal of the medical profession.
To abandon this regulative ideal by crying "miracle" is to simultaneously abandon one's identity as a scientist, and - in my opinion - as a doctor. A doctor, in the moment that he or she declares something a miracle, is not being a doctor.

Since everyone seems so keen on anecdotes, let me present one of my own - and try to imagine what the outcome would have been if the doctor involved had merely thrown up his hands and declared this a miracle (The following, long, quote is taken from Robert Klee's "Introduction to the philosophy of science : cutting nature at its seams")

In 1956 in a Massachusetts hospital a man 51 years old was released and sent home to die. A large cancerous tumor had been removed from him, but a number of other malignant tumors had been found--all inoperable. The surgeons had sewed him up in dejected resignation and his case had been filed away. Twelve years later, incredibly, the same man, now 63 years old, showed up in the emergency room of the same hospital with an inflamed gallbladder. Some doctors might have concluded that the original diagnosis 12 years earlier had been in error and think no more of it, but a young surgical resident at the hospital named Steven Rosenberg was not like some other doctors. Rosenberg made a determined search of hospital records, even going so far as to get a current hospital pathologist to pull the original tissue slides of the patient's removed tumor out of storage and reexamine them. The slides showed that an aggressively malignant tumor had been removed from the man twelve years earlier (so it was a sure bet that the inoperable ones had been of the same aggressively malignant type). During the subsequent operation to remove the patient's gallbladder Rosenberg did a bit of exploring in the man's abdomen to see if the inoperable tumors from twelve years earlier had stopped growing. The man had no tumorsat all in the places his record from twelve years earlier located them.

To Rosenberg, the man whose gallbladder he had removed presented an absorbing mystery. How had a patient with multiple inoperable cancerous tumor survived for twelve years in the apparent absence of any therapy whatsoever?
Such "spontaneous remissions" were not unknown in medicine--they have long been a central obsession of trendy occultists and other kinds of miracle mongers--but Rosenberg wanted to know the detailed why of it. He wanted an explanation of it in perfectly natural terms. He wanted to know how the everyday physiological processes of the human body--in this case, the immune system of the human body--could produce such a remission. Where less curious persons might have shrugged their shoulders in amazement and thought no more about it, Rosenberg instead proceeded on the supposition that there had to be some structural physiological basis behind the patient's remission and survival for twelve years, a structural physiological basis that was consistent with the otherwise ordinary causal operations of the human body. Rosenberg wanted to know the causal details of that structural physiological basis. If he could find out those details, especially if they were quantitative details, then the possibility opened up of being able to manipulate the physiology of cancer patients so as to destroy their cancer.

It would take Rosenberg a number of years to come up with a detailed account of that basis, but come up with it he did. Not only did he find an explanation in perfectly natural terms for the original patient's spontaneous remission, but using the theoretical account of immunological processes associated with that explanation he was able to design a complicated therapy that involves artificially growing cancer-killing immune cells outside the body. These cancer-killing immune cells, called LAK (lymphokine activated killer) cells, are injected back into the patient's body in an attempt to intervene and manipulate the patient's immune response to the cancer. Rosenberg and his colleagues have had a considerable degree of success at producing remissions with this therapy but only for specific kinds of cancer--particularly, kidney cancer and skin cancer. Apparently, knowledge of further structural detail is needed in order to be able to designLAK cells that are effective in other kinds of solid-tumor cancers.

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