SNAKE OIL, FAITH HEALING, AND OTHER DISMAL VOODOO QUACKERY: DNR

a sermon preached by the Rev. Dr. Tim W. Jensen
at the First Religious Society in Carlisle, Massachusetts
Sunday May 1st, 2005



The crisis in the American Health Care system is one of those topics that is so large, and complex, and overwhelming, that it can sometimes seem futile to try to get one's head all the way around the entire scope of the thing. It's a problem that each and every one of us, to some degree or another, has to deal with every day of our lives, whether we are consciously aware of it or not. Certainly it's something that's often on my mind, as I make my way in and out of our local hospitals visiting members of this congregation, especially now that I've started so struggle a little with some of my own chronic mid-life health issues.

But when it comes to examining the larger issue of health care policy here in the United States, just trying to figure out where to begin can be a little daunting. Is the most urgent aspect of the crisis the question of costs? -- the price of prescription drugs, the cost of health insurance, or malpractice insurance, or the ever-escalating percentage of our GDP that we spend as a society on health care? Is it the problem of coverage? -- the tens of millions of Americans (nobody really knows for sure how many) who lack adequate health insurance, or even convenient access to health care providers at any price, simply because of where they live? Or is it really the question of quality? -- how despite our amazing medical technology and the rich pharmacopeia of "miracle" drugs which inspire our politicians to boast that America enjoys "the best health care system in the world," as a people we Americans are not especially healthy when compared to the citizens of other industrialized nations: we don't live as long, have higher rates of infant mortality, suffer more chronic disease, and so on and so on and so on.

Or maybe the real problem is the way these three factors seem to be so enmeshed, and then interwoven with the financial and personal interests of various specialized constituencies like insurance companies, the pharmaceutical industry, physicians, nurses, hospitals and health maintenance organizations, medical schools, patients rights advocates, alternative healing practitioners, and dozens of others. The equation seems to be that if we want to cover more people it is going to cost us more money, unless we somehow cut quality somewhere, or cut into the profits of one or more of these other essential stakeholders, which again has ramifications for the entire system. Or if we decide the real priority is to hold down costs, how can we do that other than by limiting coverage or paying less money to the people who provide our health care services for us in the first place?

That just seems to be the hard reality of the numbers. And yet, in places like Canada (for example), they spend less money (both per person and as a percentage of GDP), cover virtually everyone, and on the whole are healthier than we are here in the United States. What is the secret of their success? Is it simply their different system? Say the words "single payer" in some circles here in the U.S. and you and you are likely to evoke a tirade against "socialized medicine," along with a litany of horror stories about triage, and rationing, long waiting periods before receiving care, and then not being able to pick your own doctor in the bargain. Yet judging from the numbers and my own experience, I have a hard time seeing how so-called "market forces" have done any better at holding down costs or increasing access...and I don't think for the life of me I will ever understand how protecting bad doctors from good lawyers helps anyone in the long run...except maybe the bad doctors.

No matter what you may believe personally, I think it's important for us all to recognize and acknowledge that ideology inevitably drives policy on some level. Our values are shaped by our ideals; and the choices and decisions we make, both as individuals and as a society, are informed by those same ideas. But when it comes to the debate about health care policy, one seemingly insurmountable problem is that there are two fundamentally incompatible ideas which are being advocated and put forward...basically by the same group of people. The first is sometimes characterized as "the Culture of Life" -- a belief that life is sacred, and should therefore always be extended for as long as possible by any means available. And the second set of values are those of the so-called "ownership society," which places individual self-determination and economic freedom within the marketplace at the top of the list of one's personal, God-given rights. In the Ownership Society, if you can afford something, you're entitled to it (and by extension if you can't, you aren't). But according to the values of the Culture of Life, if something is available that may (or may not) extend your life you are entitled to that as well, regardless of what it may cost or other any other consideration.

These two widely-held sets of beliefs work together to drive up medical costs, especially for expensive and dramatic end-of-life procedures (even those of questionable efficacy), and for so-called "elective" procedures where there are high profits to be made catering to the fears and desires of those who can afford to pay, while at the same time they tend to limit the influence and availability of more mundane public health and individual "wellness" programs where life or death not immediately at issue and there are no large profits to be made. Yet even to suggest that simply because a person can afford something DOESN'T necessarily mean that they are entitled to it, or that society has the right to refuse someone potentially life-extending therapy (regardless of their ability to pay) simply because some "authority" (other than the individual in question) has decided that the potential benefits aren't worth the expense seems a little shocking to us. Certainly it seems a little shocking to me. Like heresy really, or a sign of failed compassion and creeping totalitarianism. Yet is this really the best or only way to frame the issue?

Here are a few other considerations that have been missing from this morning's discussion so far. An effective health care system is a Social Good -- it's not just individuals, but society as a whole, that benefits when people are healthy. So shouldn't the policy be to include as many people as possible, as routinely as possible, and then to share the costs broadly and equitably? I heard the other day that General Motors lost over a billion dollars last quarter, and that one of the principal reasons they are struggling is that they need to include over $1000 worth of employee (and retired employee) health care costs in the price of every vehicle they sell, while overseas competitors from countries with single payer systems are able to avoid this expense, and price their vehicles accordingly. I don't know whether that's actually true or just an excuse, but I do recall hearing somewhere once that what is good for General Motors is good for the country. And a single payer system would certainly be good for General Motors, and other American companies struggling with the cost of providing adequate health insurance for their employees and still remaining competitive in the global economy.

I also think it's important to ask whether a health care system that is driven by "profitability" rather than by patient care is truly ethical. A system which was supposed to insure that no outside party ever come between an individual and their self-selected health care professional in the determination of appropriate patient care has now placed the interests of "health care sector" investors ahead of the rights and the needs of both patients and physicians. Pharmaceutical companies in particular have interposed themselves into the doctor/patient relationship in a particularly invasive way, in order to maximize their profits by marketing directly to "consumers" drugs intended to treat chronic conditions rather than cure specific diseases.

If I were to believe everything I see on TV, there is now a pill for every ill afflicting the middle-aged American male: Lipator, Nexium, Rogaine, Prozac and Viagra....yet I suspect a lot of us would do just about as well (or maybe even a little better) with half the beef and twice the broccoli, less time at the office (or in front of the television), and an hour's brisk walk every evening in the company of someone who delights in running their fingers through what's left of our hair, and telling us how sexy we look now that we've cut it short to match its thinness, rather than trying to hide the fact that there isn't as much there as there used to be. Meanwhile, all the marketplace can really do is to offer men a range of equally-expensive alternative choices like Cialis or Levitra....But if I ask for it, and my insurance will pay, what physician won't write me that prescription if they want to keep me from simply packing up and taking my business somewhere else?

Finally, I think it's important to remember what so much of contemporary culture seems constantly to be conspiring to help us forget: that no matter how good a system of health care we may create, we are never going to defeat death, nor even postpone it long, no matter how much money we may spend. The most important question for medical ethicists isn't really "what does it mean to be alive?" The question is what does it mean TO LIVE! What gives life meaning? What gives life purpose? What is the value of being in relationship, and the importance of being of service? How do we best make use of this amazing gift that we have been given by the Universe, by our Creator; and how do we help others best make use of their gifts? What does it mean to care for one another?

From a spiritual perspective, the goal of good medicine has always been the preservation of health rather than the denial of death. Yet market driven medicine plays upon our fear of death in order to satisfy the desire for profit, and thus is ultimately grounded in the sin of avarice, in greed. A generation ago, most hospitals in this country were still affiliated with religious organizations and administered by people of faith, as they had been since their creation. And their mission, as places of healing and hospitality, was one of charity, of loving service. Other hospitals were affiliated with teaching institutions, or run directly by the government for the benefit of the public...and many, of course, still are. But when health care became big business, much of this ethic of charitable public service was lost, and we have all suffered greatly for it. When ideology tempts us to worship the "invisible hand" of the marketplace as if it were a God, and distracts us from our more basic responsibility to help those who need our help, the essential values which make our lives ultimately worthwhile are discounted by the demands of the bottom line, and the basic quality and value of life itself is much diminished.

Now obviously there is a lot more I could say about this, and I'm sure many of you also have insights that we might all benefit from hearing. But before I go any further, just let me say that I am not suggesting, in any way, shape, or form, that hospitals don't need to worry about balancing their budgets or that health care professionals are not "worthy of their hire." Nor do I think that we should all simply throw away our meds and start taking long walks in the woods instead. Ask your Doctor. What I AM suggesting is that the most critical issues concerning our American health care system are not technical problems, but rather adaptive ones -- problems that will require us to look at the entire system from a new and different perspective, and to make changes in our own attitudes about the way that medicine should be practiced, and our own ownership of and participation in the care of what is perhaps our most (or at least second-most) precious personal possession -- the health and vitality of our physical bodies.

Reading: the Hippocratic Oath -- a Modern Version

Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.