Patrick Guinan, MD
University of Illinois, Chicago
Over 200 years ago Voltaire wrote that one half of metaphysics was known to everybody and that the other half will never be known. It is by no means certain that ethics has yet reached the same high degree of development.
At the beginnings of recorded history, the priests and the doctor were one and the same, curing body and soul, or at least pretending to do so. By the time of Hammurabi in about 2000 BC, some differentiation in function had occurred. The physician became distinct from the priest.1 But, as the Bible tells, it annoyed God that man had got too big for his boots. So he tied their tongues. Subsequently he confounded their beliefs, their religion as well.
Considering the high development of ethics, it is appropriate to ask whether it is ethical to bring religion into medicine. It would seem to undo what earlier on had been done. But the question is relevant, at least from the point of the physician, because a new religion called complementary or alternative medicine is threatening his territory.
This new discipline, or religion, provides its acolytes with nutritional supplements, vitamins, herbs, massage, chiropractic manipulations, Oriental meditation, holistic approaches, and needles inserted at the correct pressure points. A rapidly expanding industry, it already had in 1990 more visits to it (425 million) than to primary care physicians (388 million).2 Clearly allopathic medicine has good reasons to be concerned.
As different religions, such as Judaism, Christianity, and Islam, as well as Oriental Buddhism and Hinduism, developed, each developed its own approach to the problem of suffering and death, how to provide sick persons and their families with comfort and relief.
In Christianity, medical care became an obligation of the deacons of the early Church. Throughout Europe the Church organized a system of hospitals and also promoted the first medical schools in Salerno (11th century AD), Bologna (13th century AD), Padua, and Paris. In the United States, religious orders of women were the principal founders of hospitals between 1835 and 1945.3
In all religions there is a code of conduct that tends to moderate lifestyles in a beneficial way, attempting to protect its members by avoiding gluttony, sexual promiscuity, and other activities that harm body and soul. With the scientific advances of the past two centuries or so, however, an understanding of the pathophysiology of disease and more recently of molecular biology and medical technology has led to overemphasizing the material or “scientific” aspects of healing to the disadvantage of the humane aspects. Patients, in need of both, increasingly recognized this, hence the flight to new alternative or holistic approaches.
In another article in this journal, Dr. Sobel takes issue with the concept of holistic medicine, maintaining that a good doctor is doing anyway, or at least should be doing, what holistic medicine promises to be doing. But if spirituality is to be brought back into allopathic medicine, the issue still remains how to reconcile different spiritualities and different religions, especially when these occur between “provider” and “client.” So we read about pharmacists refusing to sell birth control pills. What if doctor and patient belong to different creeds and persuasions and are called upon to decide on issues of suicide, abortion, euthanasia, and other such issues that divide our society?
It has been said that academic and scientific medicine tends to ignore alternative medicine and religion, and is often hostile to both. No medical school in the United States requires courses in alternative medicine.4 An even more subtle bias against religion dates back to the Enlightenment. Yet at a time when alternative medicine is rapidly gaining ground, it behooves physicians to ponder about these problems - and once again consider that treating body and soul is truly one and the same thing.
The author thanks the editor-in-chief George Dunea, MD for help with this manuscript.
- Amundson Darrel and Ferngren Gary. Near and Middle East. In Encyclopedia of Bioethis. Reich WT., Editor, Simon and Schuster, MacMillan, New York, pp. 1440-1445, 1995.
- Eisenberg David, Kessler Ronald, Foster Cindy, et al. Unconventional medicine in the United States. NEJM, 328:246-252, 1993.
- Stepris Ursula, and Liptak Dolores. Pioneer Healers. A History of Women Religious in American Health Care, Crossroads, NY, 1989.
- Wetzel Miriam, Eisenberg David and Kaptchuk Ted. Courses involving complementary and alternative medicine at US Medical schools. JAMA, 280:784-787, 1998.
PATRICK D. GUINAN, MD, MPH is a 1962 graduate of Marquette University Medical School. The author went on to obtain a graduate degree in Public Health from Columbia University in 1965. He is presently a Clinical Associate Professor in the Department of Urology in the College of Medicine at the University of Illinois at Chicago and serves as Chairman of the Board of the Hektoen Institute of Medicine.