A REALITY BASED ETHICAL TEST FOR ABRIDGING FREEDOM OF RELIGION IN THE NAME OF MEDICAL SCIENCE.

The "50% rule" is a term used to talk about medical care. It actually is used to refer to the year, in the late1980s -- 1987 to be exact --, when a visit to the doctor became more statistically likely to help you than to hurt you.

I have been thinking a great deal about ethics, religion, chiropractic and the "50% rule." I guess it all started when I had a good chance to start thinking about what the "50% rule" really means and what it is.

Until the 1980s, medical science harmed more often than it helped. Thus, when surgeons in Los Angeles went on strike in the 1970s, overall the death rate went down. Completely denied surgery, fewer people died than when surgery was available. In the 70s, if you had a heart attack and saw a cardiologist, your life expectancy actually went down. Persons with back injuries who went to an orthopedic doctor actually averaged more time off from work than those who avoided medical care for the same injuries.

It is a scary thought. On the average, Christian Scientists were healthier for rejecting medicine entirely than the general population was for embracing medicine...

Of course "everyone knows" that in any specific situation the doctors were right and the religions were wrong. Thus, in the late 1980s, all the hemophiliacs in France that received blood products also received a death sentence -- the entire French blood supply was tainted with AIDS. While most Jehovah's Witnesses who were also hemophiliacs suffered severe health problems from refusing blood, all those who accepted "medical science" died. The same issue is alive now in Japan due to people with AIDS from "safe" blood products given them in the 1990s.

On the average, in the 1980s, Jehovah's Witnesses were healthier for rejecting medical science in France.

Everyone knows that chiropractic is actually screwy mysticism merged with pseudoscience. Yet Lancet and other studies found that on the average, accident victims treated with the techniques of chiropractic were healthier than those who went to physical therapists or M.D.s. (Of course now no one trusts the chiropractors to properly use their own techniques, see the excellent Consumer Reports article on that subject.).

On the average, in the early 1990s, chiropractic was successful for rejecting medical "science." Finally, in the mid-1990s, 75% of those who used diet to control serious seizures were symptom free inside of two years. Of those who used drugs, almost half were severely compromised in daily function.

The bottom line is that historically, since the Greeks, and through time, medicine has not been "an art" -- it has been a religion, one that was taken on faith in spite of the physical and statistical evidence that medicine was causing more harm and good. At that same time, law givers and courts were ordering people to receive "scientific" medical treatment.

What bothers me about all of this is that before the 1990s, before the 1980s, before the 1970s, back in the 1960s and before, the courts of the United States of America were intervening to force people to accept medical "science" when it was still just another brand of religion, another unproven (and generally dangerous) belief. For this we violated constitutional rights and imposed criminal sanctions when people did the scientifically correct thing in avoiding medical treatment.

Of course we know that now, in our day and age, modern medicine is more trustworthy and deserves to be enforced by court orders.

It may be that medicine is becoming a science rather than a religion or just another form of magic art. I believe so. I hope so. I spend my money and put my trust in doctors. But then I am a believer in statistical validation and in properly conducted studies and protocols.

Those studies tell me that medicine is a good bet now. But those studies also tell me that the basis for the precedents upon which we now justify intervention in violation of religious freedom -- those precedents were factually wrong and supported only by faith in medicine over other types of religion -- a misplaced faith at the time.

In those cases, Courts ordered parents to accept a system that had the overall record of being more likely to harm than to help. That is, a system where we now know that the preponderance of the evidence was that no one should take the risk and that the parents were doing the right thing.

Of course, in some circumstances, the Courts were right. But the doctors handling back injuries were as certain as the ones who handled broken bones. The surgeons doing appendectomies were as certain as those who removed tonsils. The M.D.s performing inoculations as convinced as the ones practicing cardiology.

In fact, being honest, the vascular surgeons and cardiologists were at the top of the profession and the most certain. The doctors who were the most wrong were also the most respected and the most certain about what they were doing. Remember, they may have been the most certain and the best paid but they were also "just the most wrong. "

Even now there are entire areas of medicine that on the whole (generally as practiced by "old fashioned" doctors) harm more than they help. Thus, in 1995-1996 Southern California, Asians and Hispanics who go in for inoculations, antibiotics and trauma care, while otherwise being "under served" -- those minority groups are healthier than Whites who receive a "proper" level of medical care.

For a variety of reasons, those cultural groups seek out medical care that passes the 90% test (90% or better likely to help) and avoid the types of medical care that fails the 50% test (break even or worse chance of helping rather than harming). It is no surprise that they are healthier than groups who receive both kinds of treatment.

Putting aside the national policy issues in making national health care plan decisions, consider the ethics in forcing the acceptance of medical care on Hispanics or Asians or others. Is our certainty upon which we justify such drastic intervention, is that certainty properly founded?

It wasn't in the 1950s. It wasn't in the 1960s. It wasn't in the 1970s. For parts of the 1980s it wasn't. It was a death knell for some in the 1990s. What makes it certain enough to justify harsh and almost punitive intervention in 1996 and beyond? Where is the solid evidence that this time we are really right, that this time we have plugged all the holes, covered all the risks and that this time we can promise to be right?

As soon as I see written guarantees from doctors and judges, then I'll believe it. If it is real science, then rather than "local medical practice" the standard of liability and of responsibility in seeking a court order should be scientific certainty. Until those involved are willing to be that responsible, I must retain serious questions about the ethics of intervention and serious certainties about the lack of science in medicine.

If you disagree with me or are interested in a good start on researching the issues, start with Where is the wisdom ...? The poverty of medical evidence, British Medical Journal Volume 303 5 October 1991. In a properly done study, only 15% of medical interventions reviewed were supported by solid scientific evidence. The evidence strongly implies that it is more likely than not that the sample group's ratio is the same for all medical interventions. Follow the current research building on that 1991 work and reach your own conclusions.

Until then, consider the ethical weight of forcing what is basically a religious decision, based on faith, upon other people whose faith is different than yours.

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