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Health, Science, and Religion in Contemporary American Culture

2003; Elsevier BV; Volume: 78; Issue: 7 Linguagem: Inglês

10.4065/78.7.893

1942-5546

Imre Loefler,

Adolescent Sexual and Reproductive Health

In contemporary society, health and longevity are overriding concerns. Health is understood as freedom from disability. Because of advancements in chronic disease management-a technological development of the 20th century-there is no compelling linkage between freedom from disability and longevity. An increasing proportion of people live with disability for many years; they benefit from “health care” without hope for cure. Preoccupation with disease and death is part of the human condition, yet never before has any society regarded health and longevity as the ultimate goals of human endeavor. Never before has the success of a society been measured in terms of life expectancy.1Loefler I Is longevity a sustainable goal?.BMJ. 2002; 325: 665Crossref Scopus (1) Google Scholar The concept of health vs disability has acquired a new dimension with the notion that the life of the disabled individual may hold varying degrees of “quality.” Although one of the original loci of the quality-of-life debate was the intensive care unit, new quality-of-life considerations encompass a whole array of situations such as congenital anomalies, dementia, complete permanent dependency, and life with intractable pain. The discussion is bedeviled by insoluble problems, among them that assessments of quality are subjective and depend on preconceived value systems. This is so, despite the fact that there are now certain “validation instruments” with which quality of life can be measured. These instruments are largely concerned with symptoms, signs, and disabilities or their absence, and hence they medicalize the quality of life.2Sloan JA Aaronson N Cappelleri JC Fairclough DL Varricchio C Clinical Significance Consensus Meeting Group Assessing the clinical significance of single items relative to summated scores.Mayo Clin Proc. 2002; 77: 479-487PubMed Google Scholar, 3Sprangers MAG Moinpour CM Moynihan TJ Patrick DL Revicki DA Clinical Significance Consensus Meeting Group Assessing meaningful change in quality of life over time: a users' guide for clinicians.Mayo Clin Proc. 2002; 77: 561-571Abstract Full Text Full Text PDF PubMed Scopus (145) Google Scholar Accordingly, society has great difficulty-even in the most extreme and seemingly self-evident situations-in forgoing quantity of life for quality's sake. Quality-of-life considerations have always been part of medical care. One of the tenets of the school of Salerno almost 1000 years ago was “Non est curare sed comfortare, premium vitae” (the gift of life is to comfort, not necessarily to cure). The Oxford Textbook of Surgery4Morris PJ Malt RA Oxford Textbook of Surgery. Oxford University Press, New York, NY1994: 2643Google Scholar states, “When a person is close to death the primary aim of treatment is comfort. … All patients must die eventually, ultimately nature will take its course.” Lately, it has become customary to express old verities in a new language, sometimes in a pretentious language, for example, “Palliative surgeons [sic] acknowledge that death can be a natural and expected outcome of an advanced disease process …”5Easson AM Lee KF Brasel K Krouse RS Clinician research for surgeons in palliative care: challenges and opportunities.J Am Coll Surg. 2003; 196: 141-151Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar; or “A concentrated focus on quality of life outcomes in addition to quantity of life distinguishes the palliative surgeon. …”5Easson AM Lee KF Brasel K Krouse RS Clinician research for surgeons in palliative care: challenges and opportunities.J Am Coll Surg. 2003; 196: 141-151Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar Whatever the philosophical, scientific, and religious assumptions about life may be, there is no doubt that a sizeable proportion of contemporary Western societies value security, risk avoidance, health-related quality of life, and longevity higher than liberty, creativity, and the search for beauty and truth. In the words of Peter Skrabanek,6Skrabanek P The Death of Humane Medicine and the Rise of Coercive Healthism. Social Affairs Unit, St Edmundsbury Press, Bury Saint Edmunds, England1994Google Scholar rich Western societies are becoming “healthist.” If healthism is one preponderant cultural trait of our times, another is the belief that science can and will improve the human condition. Although this attitude toward science is prevalent, it is not unambiguous. Most people are utilitarian in outlook; they desire to partake in the technological achievements that scientific endeavor bestows, including gains in health, longevity, comfort, leisure, and excitement, yet rationality itself is not considered of supreme value. There are many countercurrents that use technology to the fullest and propagate the use of the scientific method in every aspect of life, yet remain essentially antirational. America is the only Western nation in which religion has not atrophied. To the contrary, in America, religion is becoming again a potent factor in public life. Because of 2 cultural characteristics, political correctness and the related multiculturalism, religion itself, not any given religion, is gaining importance. Therefore, it is not surprising that sooner or later the obsession with health and longevity and the search for health-seeking behaviors should have focused on religion. Could it be that religion has survival value here on earth? This question has been formulated as a hypothesis that has been subjected to Popperian scrutiny. Scientific debate concentrating on the falsification or other aspects of this hypothesis occupies a growing proportion of the pages in American medical literature. Two topics dominate this debate. One is epidemiological and focuses on the issue of whether religious people live longer and are healthier; the other is therapeutic and concerns the efficacy of prayer, intercessory prayer in particular. The answer to the question of whether religion is good for health appears to be yes in cross-sectional and in cohort studies.7Mueller PS Plevak DJ Rummans TA Religious involvement, spirituality, and medicine: implications for clinical practice.Mayo Clin Proc. 2001; 76: 1225-1235Abstract Full Text Full Text PDF PubMed Scopus (369) Google Scholar Apart from the fact that such studies are not capable of ascertaining causality, there seems to be little doubt that cohorts of people who gather to pray and sing in churches, cathedrals, mosques, and temples are known to avoid risky lifestyles: most eschew smoking, drinking, and drugs; are not promiscuous; are not violent; and are generally continent. One problem overlooked in some of these studies is that continence and moderation and the avoidance of pubs and brawls are not unique to religious people. Articles that report on the earthly survival value of religion and spirituality go beyond the mere question of healthy lifestyle. Evidence is adduced to show that belief in God and an afterlife is conducive to a longer and healthier life on earth if the religious beliefs do not lead to unhealthy lifestyles and the refusal of treatment. It is acknowledged that religious extremism and armed conflicts in the name of religion constitute risky behaviors. What is astonishing is that so much labor and sophistication are expended to prove something that should be expected. People who believe that they know from whence they came and why they exist, people who believe that there is a personal God who is omniscient and provident and who takes interest in them personally, and people who believe that death is but a preliminary event before resurrection and eternal life are bound to be less worried and less unsettled than those who are bereft of such certainties. It should come as no surprise that research shows that the terminally ill who die believing that they will continue to live, die more peacefully than those who assume that death is final.8Cartwright A Is religion a help around the time of death?.Public Health. 1991; 105: 79-87Abstract Full Text PDF PubMed Scopus (16) Google Scholar We would expect religious people to have better coping mechanisms in life and when facing death than do those who are unbelievers. It is beside the point to ask why someone who believes in heavenly rewards would want to prolong earthly existence almost at all costs. What is difficult to explain is that the comparative earthly survival value of religion is not much greater than what is being shown by assiduous research. Philosophers who believe that the concepts of divinity and religion are human inventions have always maintained that the stimulus for erecting a comprehensive edifice for matters supernatural has been the incomprehensibility of existence and the concomitant suffering and death. To conclude, it seems that those who believe indeed may be blessed or, more prosaically, are at an advantage. A special branch of research into the health-longevity-religion complex concerns itself with the therapeutic effects of prayer, intercessory prayer in particular.9Harris WS Gowda M Kolb JW et al.A randomized, controlled trial of the effects of remote, intercessory prayer on outcomes in patients admitted to the coronary care unit [published correction appears in Arch Intern Med. 2000;160:1878].Arch Intern Med. 1999; 159: 2273-2278Crossref PubMed Scopus (328) Google Scholar, 10Aviles JM Whelan E Hernke DA et al.Intercessory prayer and cardiovascular disease progression in a coronary care unit population: a randomized controlled trial.Mayo Clin Proc. 2001; 76: 1192-1198Abstract Full Text Full Text PDF PubMed Scopus (106) Google Scholar The question is, are such studies, conducted at the gold standard level of medical research-the controlled randomized trial-good science and, for that matter, good religion? Study investigators who examine the effects of intercessory prayer try to use the scientific method with impartiality. They attempt to treat prayer as if it were a substance or a modality of energy or perhaps a manipulation. They assume prayer to be part of the observable, reproducible, and factual world. Thus, the possible effects of prayer are examined with great thoroughness, whereas prayer itself is exempted and not defined, described, observed, or quantitated. The investigators of such studies usually recognize that their work has certain methodological weaknesses (the question of “dose” or the possibility that controls may have benefited from unsolicited and unknown intercession), yet they do not seem to entertain any doubt that the scientific method is capable of examining prayer, the essence of which is a subjective, private, and devout communication with something or somebody not observable and therefore not subject to the laws of the physical universe. The scientific method, including the strictly controlled randomized trial, is incapable of examining the supernatural because the supernatural, by definition, is exempt from the strict tenets of reproducibility. The concept of an automated God granting a “favorable outcome” in a given proportion of cases with a predictability of statistical significance is an abomination. According to all great religions, God deigns: he is inscrutable; his wisdom is incomprehensible; he is not bound by any law and not obliged to hear prayer. All religions try to make deals with God and extricate promises in the form of covenants and sacramental obligations, yet no world religion has suggested that God's mercy is experimentally testable. In terms of Christian tradition, trying to prove that it is useful to believe in God is an aberration. In terms of the contemporary American version of Kulturkamf, it can be said that religion is presently gaining on science, not by displacing it but by corrupting it. This is dangerous for science and demeaning for religion. There is also a looming peril: Suppose that after more and more meticulous research a consensus emerges, according to which intercessory prayer has no proven survival value for the “recipient.” Will entreaty on behalf of the sick be discarded as was bloodletting, mesmerizing, and purging? Medical science is out of bounds when it wishes to prove or disprove the supernatural. Conversely, faith, faith in God, faith in resurrection and eternal life, and faith in prayer cannot be replaced by scientific proof because if this were possible, it would cease to be faith. Paulus says, “Faith is the substance of things hoped for, the evidence of things not seen” (Hebrews 11:1). Believers do take a chance. To assume that science can diminish that risk is naive. It is hoped that the editors of scientific journals will avoid continuing this essentially medieval debate. The humanists have shown that philosophy and science are not the maids of religion. What a pity if Americans discarded one of the guiding principles of their history: enlightenment. What enlightenment has not changed, and what reverting to medieval sophistry must not change, is this: Physicians, believers or unbelievers, are obliged to take cognizance of their patients' beliefs. Compassion and common sense dictate that religious desires be satisfied within the bounds of the lawful and practicable.