Hit me with your best shot

No vaccine for stupidity

Even before the recent news flurry over anti-vaccine spokesmodel Jenny McCarthy and the status of her son's reported autism, there was a provocative news item in the Sacramento Bee concerning a new medical clinic designed for parents who need assistance in opting out of California's childhood vaccination program, recently made more stringent by long overdue changes in state law. The clinic's founder, Dr. Dean Blumberg, supported the new state law but also describes himself as a firm supporter of parental rights:

“I’m pro-immunization, but I’m also in support of parental rights,” Blumberg said. “That’s why we decided to set up the clinic as a community service, in case there are parents whose health care provider won’t sign the [exemption] form or some parents who don’t have a primary care provider.”

The Bee article generated a laudatory letter to the editor:

Dr. Blumberg helps no-vaccine parents' right to choose

Re “Clinic to aid no-vaccine parents” (Our Region, Dec. 19): Surely, we as doctors and parents can debate the many merits of and concerns with vaccination programs. However, UC Davis Medical Center physician Dean Blumberg has taken a position that is both praiseworthy and responsive to parental rights. As a parent working in emergency medical services, I have decided not to participate in vaccination programs for reasons that are really not at issue. What is at issue is that we are afforded the right and responsibility as parents for our children. I encourage Dr. Blumberg to continue providing information to assist parents in our choices and to continue honoring us as parents as we evaluate this information and make our decisions. The doctor should be recognized for his commitment to the higher standard of self-determination in the practice of pediatric medicine. —CK, Roseville

I was inspired to submit a response that the Bee did not see fit to publish, so I offer it here:

Anti-vaccination parents who leave their children vulnerable to preventable diseases are always so eager to appear rational and reasonable. As one said in Letters, “I have decided not to participate in vaccination programs for reasons that are really not at issue.” Not at issue? How delusional a statement is that? How would people react if a parent said something only slightly different? For example: “I have decided not to use child safety seats in my car with my children for reasons that are really not at issue. In case of a traffic accident, I prefer to hope that my children will be thrown clear.”

The medical merry-go-round

Caught in referral hell

It seemed a good idea at the time. Heck, it still seems like a good idea. People did try to help out and some leads were followed. So they turned into dead ends. Whose fault is that? Everyone who offered suggestions deserves thanks.

I prefer to blame the doctors.

Frankly, it's like they're playing a game of keep-away with a friend of mine. However, instead of swiping some short kid's cap and tossing it back and forth over his head, it's more like they're lobbing his medical file to and fro: “Here! You take it!” “Hell, I don't want it! You take it!”

I get it. They can't figure out what's wrong with him, so they ignore him as much as they can (this part is easy, because they are actually very busy people with easier cases to consider) and then try to make him someone else's problem when he gets to be a nuisance. My buddy wouldn't mind this latter part so much if at least someone in the long-running game of tag-you're-it could actually make sense of his situation.

As previously reported, one of my good friends (we go back all the way to the height of personal computer fun, West Coast Computer Faires, and user groups) is suffering from a combination of symptoms that include ferocious migraines, loss of voice, and a strangling sensation of throat constriction. Doesn't sound like fun, does it? Initially it seemed like his lymph nodes were going crazy, but now it appears the swelling and constriction must be from some other cause. His thyroid levels were messed up, but medication to bring his numbers under control had no impact on his other ills (even though the thyroid tests got back into the normal range). It's as puzzling as ever. Here's his most recent update:

I have seen three different otolaryngologists in three different clinics: One at UC Davis, one at UCSF, and one at the Sacramento ENT clinic. No one could find a cause in my throat. I followed up by seeing an endocrinologist at the UC Davis Elk Grove clinic. He ruled out my thyroid causing the problem and also ruled out Riedel’s thyroiditis as a potential diagnosis. On July 26 I saw an allergist at UC Davis and she ruled out allergies as a cause because allergies come and go. She suggested I go back to the UC Davis ENT clinic because the doctor I saw at that clinic said that I should see them again if the problem persists; the allergist said I should see them for voice and swallowing problems. I told her that would be useless because all the doctors I’ve seen are trying to address the symptoms, not the cause.

The swelling continues to grow in several places that have been swollen for a while, and a new area of swelling appeared on the back of my neck in the last week.  I’m starting to feel more pressure and pain on my throat when I lie down, which makes it even harder to get comfortable when I need to sleep. Twice this week I’ve slept for 8 hours at a time only to wake up exhausted. I still have no appetite and I’ve lost nearly 19 pounds since this started 4.5 months ago – I was at 163.8 pounds when I started and I’m now down to 145.2 pounds. I’ve asked my current primary care physician about next steps including a PET scan and a follow-up ultrasound scan. I’m currently looking for a new PCP.

He doesn't mention it, but his PCP's referral to the UCSF otolaryngologist provoked an irritated response from the latter, whose specialty is oncologic surgery; he was clearly irked at being sent a patient with no indications for cancer. The wasted trip to San Francisco was further evidence that his primary care physician is out of ideas and is randomly sending him around, hence the search for a new primary. And for a new referral that finally produces results.

Anyone out there have any ideas? Are you a retired diagnostician with time on your hands and an itch to solve an intractable problem? Everybody needs a hobby!

The situation gets monotonically worse, with neither diagnosis nor remedy on the horizon. What can we do to get this guy out of purgatory?

And please don't suggest prayer.

It's a headache!

And that's not all

A friend of mine is (figuratively) banging his head against a brick wall. The results are similar to what they would be if his activity were literal.

Interestingly enough, his medical condition began quite misleadingly. Eventually his doctors figured out that his symptoms of disorientation, dizziness, and weakness were the results of “silent” migraines. While migraines are most commonly associated with acute, debilitating headaches, this is not the only case. The headaches might be absent, while the victim nevertheless experiences the distorted vision and weakness that migraines induce.

The diagnosis of silent migraines resulted in my friend's introduction to the extensive pharmacopeia of anti-migraine medications. Problem solved!

Sort of. Temporarily, anyway.

Things began to change. For one thing, my friend's prescriptions worked for only a limited time. As he became inured to the therapeutic effect of one drug and the symptoms ramped back up, the doctors would move him on to another. He was now working his way through the list of drugs, wondering how long this could go on. For another thing, the pain showed up. Classic, stabbing, excruciating headaches. “Silent” no more. Fortunately for my friend, the sharp, stabbing headaches are intermittent—triggered by loud noises (he suffers from hyperacusis). Only the dull pain in his head is constant, day in and day out (and denying him sleep, because there's no longer any such thing as a soft-enough pillow).

Now he was getting passed around in the medical community. The UC San Francisco headache clinic looked into his case and shot him up with drugs to “reset” his pain level. It failed. UCSF was on the verge of confining him to a hospital bed for a days-long infusion of a drug that required 24-hour monitoring when a bad reaction to a milder form of the medication provided a very serious contraindication.

The UC Davis Medical Center subjected him to a series of tests, none of which proved definitive. It was clearly something more than just a migraine condition. My friend was wobbling about with a cane and it took a regimen of physical therapy to help him relearn how to stay upright and walk like a sober person. The migraines had laid waste to his balance system.

The standard migraine drugs were used up and then recycled at higher and more dangerous levels. Relief was still merely temporary and palliative. His doctors began a series of off-label prescriptions (where “off-label” means using medications to treat conditions for which they are not formally approved). It was, in a word, a series of experiments. Each experiment lasted as long as a month or two. Much shorter, of course, in the case of hallucinations or other serious reactions. Recently the doctors started mumbling about using botox, but I'm not sure what that's all about.

But that was merely prelude. This year his condition escalated in a completely unexpected way. Let him tell it in his own words. It's a total mystery:

In early March I started to experience swelling in the front center of my neck. A couple of days later there was a small lump on the back of my neck. The lump in the front of my neck has continued to swell and the swelling has grown into my jaw. This past weekend a new, fairly large lump has appeared at the intersection of my jaw and neck just below my right ear. The swelling in my neck has put enough pressure on my neck to cause difficulty swallowing, occasional difficulty breathing, and the loss of my voice. (I can only talk in a whisper.) I have also had swelling in both underarms and in my groin, but the doctors can’t feel anything in those spots that would warrant more testing.

Blood tests suggested that I have hypothyroidism, and I’ve been taking levothyroxine (50 mcg/day) for over a month to combat that potential cause. The levothyroxine has lowered my thyroid stimulating hormone level to normal, and I’m still taking it per my doctor’s orders, but that drug hasn’t lowered the existing swelling, kept existing swollen areas from growing, or prevented new growths from forming.

I’ve had three ultrasound tests of my neck and though these tests have found a slightly enlarged lymph node that hasn’t grown or shrunk in the subsequent two tests, the node is too small for a biopsy. I’ve also been to the ENT and to a gastroenterologist without any success or insights. My primary doctor is now at a loss about what to do next.

While lymphoma has been suspected because of the swollen lymph nodes, nothing has ruled it definitively in or definitively out. The constellation of symptoms is totally confusing.

And Hugh Laurie is busy wrapping up his final season of House and isn't taking new patients.

Any ideas, anyone? Know anyone who might? Perhaps you have a better clue than any of my friend's doctors. They keep passing him back and forth like a hot potato, cheerfully suggesting to him that his life isn't really at risk because they can always resort to intubation if his throat becomes too constricted to permit adequate breathing. It's a comfort, isn't it?

Please feel free to pass this post along, link to it, or otherwise bring it to the attention of medically savvy professionals who can solve this puzzle. It's a headache—and then some.

God's utilitarians

The meanies justify their ends

Someone had been busy. Each car in the parking lot had its own copy of an anonymous flier. I pulled the document out from under the windshield wiper. Large letters said “A B C.” Upon closer inspection, the fine print delivered the message:

Abortion = Breast Cancer

The flier was a simple one-fold document, the interior of which went on to explain breathlessly that “post-abortive” women were at severe risk of breast cancer. A woman's body, you see, goes slightly crazy when frustrated in its divine mission to bear young and unfulfilled hormones wreak havoc in the mammaries. Hence the battle by “pro-life” forces against abortion is also a battle to save women from horrible and disfiguring disease—and even death.

It's science, people. You have to believe in science. (Except, of course, when those same crazy-ass scientists go on about evolution, global warming, or that nonsense about a billions-year-old earth.)

The so-called ABC connection between abortion and breast cancer is a favorite talking point of the anti-abortion activists. It is routinely cited on Catholic Radio and fliers like the one I found on my car keep insisting that the link is established beyond any reasonable doubt. They like to give numbers, too, such as “28 studies reveal increased risk.” The cherry-picked reports, however, include results deemed not significant (in the statistical sense) and no hint is given that the preponderance of the evidence goes in the opposite direction. As the National Cancer Institute puts it, in the affectless diction of a neutral science-based agency, initial research in the area was ambiguous, based on small sample sizes, and produced inconsistent results:

Since then, better-designed studies have been conducted. These newer studies examined large numbers of women, collected data before breast cancer was found, and gathered medical history information from medical records rather than simply from self-reports, thereby generating more reliable findings. The newer studies consistently showed no association between induced and spontaneous abortions and breast cancer risk.

That is the consensus of modern medical science, but the pro-lifers still cling to the handful of early studies that went their way.

I always find it irksome when some wrong-headed group tries to co-opt science in support of its non-scientific objective. Creation “science,” of course, is a prime example of the perversion of science in the service of sectarian interests. I have, however, a particular disdain for the sheer opportunism exhibited by people like the ABC proponents. Contrary to their supposedly deep-held principles, they are fully prepared to embrace the notion that the ends justify the means. It's a pragmatic utilitarianism that I suspect most of them would instantly disavow, but here's another place where the evidence goes against them.

For example, anti-abortionists emphasize that terminating a pregnancy is the killing of human life. Many of them are willing to call it murder and express the wish that health professionals who perform abortions be tried in courts of law under homicide statutes (and then, somewhat inconsistently, some anti-abortionists want them subjected to capital punishment after conviction). It is, therefore, a great moral crusade against a heinous crime that society at large has so far been blind enough to permit.

Doesn't it severely undermine the moralistic argument to append a health warning? “Oh, and don't forget that you'll get breast cancer if you do it!” The ABC issue is irrelevant to the faith-based moral argument. Its inclusion is nothing more than a concession to pragmatic realpolitik. Yet I never hear apologists on religious programs concede that point. They toss in the ABC argument as if it's equal in status to their abortion-is-murder claim. The disproportion should be dizzying to the conscious brain, but it appears that this does not bother most anti-abortionists. (In fact, not any that I've ever seen.)

Down on your knees!

My recollection of the ABC flier was prompted by a recent e-mail that I discovered in my spam folder. The nice loons at Newsmax Health (as distinguished from the loons that infest all the rest of Newsmax) wanted me to be aware of the health benefits of prayer. No, not the long-discredited notion that intercessory prayers could speed one's healing. This message was about the benefits to oneself. Prayer, by golly, is good for you!

1. Can modern science explain prayer?
2. Does praying strengthen your brain and prevent mental decline?
3. What benefits, if any, does prayer offer you — physically, mentally, and emotionally?

That's a pretty good teaser. I'm sure you're as excited as I was at the prospect of learning the answers to these weighty questions. A free video (28 boring monotone minutes) is available to tell you amazing facts:

• How a specific amount of “prayer time” per day can help prevent memory loss, mental decline, and even dementia or Alzheimer's . . .
• The #1 prayer pitfall that can actually make you sick if you're not careful (this is one of the most important bits of wisdom you'll ever gain) . . .
• 47 scientifically proven benefits of prayer, including pain relief, reduced risk of death from heart attack or stroke, lessened anxiety or depression, and more . . .
• And much, much more . . .

Want the details? Newsmax Health will send you two free copies of its Mind Health Report! (And more, if you subscribe for only $36 for twelve monthly issues. You knew we'd get there eventually.)

Of course, this is science. (Remember “science”?) The founder of “neurotheology” is a real scientist (well, an M.D., anyway) at a real medical research center (well, an “integrative medicine” center, anyway). As a totally careful scientist and researcher (and stuff like that), the researcher began with a formal definition of the phenomenon being studied. Namely, what is prayer? I wasn't surprised by the research paper involving the rosary. That's pretty traditional and old school. But there's a much broader non-sectarian approach to what is called “prayer.” Here's the definition from the beginning (at 4:41) of the tedious video!

So, for the purposes of our research, we defined “praying” as any mental activity that includes

• traditional prayer practiced by people of religious faith
• meditation, or contemplative reflection on a power greater than oneself, which can be God, the Universe, or all Life
• focused positive thinking, such as speaking affirmations
• attending a church or synagogue service

How's that for a tight focus? When you bundle it all up, it amounts to meditation of some kind. Period. (Even in a church or synagogue, which were specifically cited. But not, apparently, in a pagoda or mosque.) The results, of course, merely indicate that quiet contemplation is good for you. It says nothing about the efficacy of prayer qua prayer. Newsmax is trying to sucker its conventionally religious readers into ponying up some cash to wallow in “scientific” validation of their prayer practices. We should “pray” because it's good for us—not because it works in any conventional way as a nice chat with one's deity.

Nice work, Newsmax!

I know that I could dig out my credit card and send Newsmax Health some money right now for a subscription to what I'm sure would be a rich and reliable vein of unintentional humor. However, I really think I should pray about it first. Or, as I prefer to call it, a “nap.”

Another non-miracle miracle

Get well, Allen Wright

I hope Allen Wright beats the odds and experiences a full recovery from the hit-and-run accident that put him in the hospital on Sunday, March 13. He's the teenager who received some previous publicity for his invention of “A Note to God,” an iPhone application that delivers messages to ... well, no one. However, users of the application get to enjoy sharing their prayers anonymously with other believers (and only God will know who they are). It hardly seems necessary to acquire an iPhone app to send God little notes, but what-the-hey, it's a digital age.

Anyway, today's headlines report that Allen is out of the eight-day coma that followed the accident and he is responding—apparently with some comprehension—to family members and medical personnel. It's a very encouraging sign.

But it's not a miracle, despite what some devout people want to believe. Here are some comments posted by believers on the website of the Sacramento Bee:

Miracles do happen...Awesome....

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God always has a way of turning a negative situation into a positive one!

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My first thought is, "God has answered your letter Allen".

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It's a miracle from god that he brought Mr. Wright out of his coma.

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to God be the glory! Yes, there is power in prayer. And I guarantee, that every one of you reading this post, would begin praying when ANY family or friend becomes ill or experiences an accident.

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That news gave me the chills. What an awesome God we have.

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Divine Intervention.

Did the “awesome God” who allowed Allen to wander into the path of a speeding car decide to tidy up his own mess and divinely intervene to restore his victim to consciousness? Did he repent of his plan to take out the boy who was spamming him? The Bee tells a slightly different story. The doctors at Mercy San Juan Medical Center injected Allen with drugs to deepen his trauma-induced coma. It was an attempt to protect the patient by reducing brain swelling, giving him time to heal without suffering the additional trauma that brain-swelling would induce. After one week, the doctors withdrew the sedatives. Within hours, Allen opened his eyes.

Not exactly a miracle, but still an encouraging sign. He then demonstrated that he could respond to questions by sticking out his tongue. Quoted in the Bee, neurologist Kavian Shahi said, “One of the most important things we like to see from patients is whether they follow commands. It indicates they can understand language and react to language. It takes a lot of brain power to do that.”

The Bee reporter asked Dr. Shahi if Wright's awakening was aided by the prayers offered up on his behalf. The doctor gave a discreet response:

“Sometimes I think it does. Sometimes I think it doesn't,” he said. “I don't actively encourage it. But in my opinion, it never hurts to pray.”

No, it never hurts to pray. I encourage all believers to do so regularly. It keeps them out of trouble and out of our way. Praying for Allen isn't going to do him any good, but it might calm the nerves of those who pray. I guess that's good. Sort of.

Allen's brain, which probably still thinks there is a God, may be on the mend. Let's hope so. But I won't bother to pray.

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Allen Wright's recovery, whether complete or partial, is certain to be difficult and probably lengthy and expensive. A fund has been set up: Allen Wright's Foundation for a Better Life, Wells Fargo, 6047 Sunrise Boulevard, Citrus Heights, CA 95610.

No separation of church and press

God takes credit for doctor's work

Oleg Savca is a lucky boy. According to the Sacramento Bee, Oleg is an 11-year-old Moldovan who has undergone successful brain surgery to remove a tumor. The medical procedure, conducted last month at Sutter Memorial Hospital in the state capital, almost certainly spared him from a painful death. Oleg is feeling well enough now to return home, thanks to the doctors whose skills saved his life.

Oops. Sorry. Did I say “doctors”? I meant to say “God”! That's who saved Oleg's life, you see. I know because I read it. Here are some direct quotes from the Bee's article (emphasis added):

He was first diagnosed with hydrocephalus, a buildup of fluid inside the skull. When doctors found the tumor, they told the family they did not have equipment to remove it.

“They didn't even have the microscope—didn't have the ability to see what they needed to see,” said Dr. Samuel Ciricillo, medical director of the Sutter Neuroscience Institute and the neurosurgeon who would eventually operate on Oleg.

Left alone, the tumor would put Oleg into a coma and ultimately kill him. What happened next Zina Savca can attribute only to divine intervention.

The Savcas' doctor, Andrey Plesco, visited Sutter Memorial in late April on a professional exchange. He saw Ciricillo operate and realized Ciricillo could save the boy.

Apparently Dr. Plesco realized in some kind of divine vision that Oleg needed a brain surgeon and that Dr. Ciricillo is a brain surgeon. Nice of God to intervene that way. It's not as though Dr. Plesco could have recognized the connection on his own.

Thanks, God!

Next time, though, consider not giving the boy a tumor in the first place.

It quacks like a duck

The old wives strike again

The speed of light allegedly limits the rate of transmission of information. When it comes to bad news in my family, I'm not certain the limit applies. Sometimes I get reports of tragedy before they even occur. It's a gift that my family has.

Mom was on the phone. She had news about my niece's cousin's husband.

“Who?”

“He's married to your sister-in-law's niece.”

“Okay, I guess I could parse that out, Mom, but Phyllis has a whole bunch of nieces on her side of the family and I don't know them, let alone the spouses of the married ones.”

“His name is Kyle and he came down with multiple sclerosis.”

“Well, damn, that's a tough situation for a young man, Mom, but the news really doesn't mean that much to me.”

Mom paused for a few seconds. Had I offended her by my lack of interest in the poor fellow's plight? When she broke her silence, it did not immediately clarify the matter:

“I know you're not going to want to hear this.”

Now it was my turn to be silent. Then the light hit me and I understood. I knew exactly where she was going:

“You're absolutely right, Mom. I don't want to hear it. You can just drop it.”

“Phyllis got Kyle to go to her doctor.”

She went there anyway.

“Mom, Phyllis's ‘doctor’ is not a doctor.”

Short of sticking my fingers in my ears and yelling “La-la-la-la,” there was nothing I could do. Mom insisted on telling her story.

“Pat is too a doctor. She's the one who figures out illnesses by looking in your eyes.”

“She's not a doctor, Mom. Iridology is not a medical technique. It's quackery. You cannot diagnosis illnesses by looking at the colored part of the eye. She's not a doctor.”

Mom was talking right over me. The woman is relentless.

“She looked at Kyle's eyes and told him he had to stop using artificial sweeteners.”

“Fine, Mom. No harm there. But that's just semi-pointless advice from a new-age practitioner.”

“But Kyle got all better! He stopped drinking sodas with artificial sweeteners and took the medicine Pat prescribed for him and he's all better!”

“Yeah, right. She cured Kyle's MS by getting him off aspartame. Mom, she's not a doctor. And she can't prescribe drugs. It's against the law.”

But now it was Mom, of course, who was going “La-la-la-la.”

“Well, she did. She told him to take mega-vitamins and gave him some herbs, too.”

“Vitamins and herbs are uncontrolled supplements, Mom. Anyone can recommend them. Anyone can take them. They're not prescription drugs. She can't prescribe drugs because she's not a doctor. Am I not making myself clear?”

“I knew you would say that, which is why I didn't want to tell you about it.”

(Who called whom, Mom?)

“Mom, was Kyle actually diagnosed with multiple sclerosis?”

“That's what everyone said he had. I don't know if he went to a doctor for a formal diagnosis.”

Mom makes “formal diagnosis” sound like a foolish and expensive indulgence.

“You don't know if he went to a real doctor or not? Then it looks like Phyllis's fake doctor gave Kyle fake drugs for a fake cure for his fake disease. And what do you know? It fake worked!”

“You know, Zee, there's just no talking to you when you get like this.”

“Well, Mom, here's some advice for next time: I am always like this! Take some ginkgo biloba so that you remember that your son is not interested in stories of credulous acceptance of quackery. The ginkgo doesn't actually do anything except perhaps induce a placebo effect in the gullible. In your case it should be pretty powerful.”

“Oh, honey, you are so close-minded!”

Half of my genes are from that crazy old lady. Oh, dear.

Looking at you, kid

Arrgh! I'll keep an eye on it!

My father's right eye is somewhere in a University of California medical lab. It came into their possession after a surgeon extracted the blind orb and set Dad up for a glass replacement. He's been a one-eyed man for several years now, though he has yet to find the land of the blind in which he could be king.

Did the UC med school find anything interesting in my father's eye? I'm more than merely curious these days, especially since last year, when my ophthalmologist told me that the retina of my left eye was scarred. (Dad's right eye. My left eye. We're as opposite as can be.) The eye doctor opined that the likeliest cause of the scarring was a leaking blood vessel, but there was no indication of leakage into the vitreous and I could not report any significant incidents that would have confirmed such an episode.

My ophthalmologist decided that no immediate intervention was indicated, but that we should “keep an eye on it.” I dutifully laughed at what I assumed was an eye doctor's favorite joke, but her advice seemed reasonable enough. She referred me to a retinal specialist for a second opinion, who quickly concurred with my ophthalmologist's recommendation:

“I think she's right. No intervention is indicated. We could zap it with a laser, of course, but the potential risk outweighs the likely benefit at this point. You should let us know immediately, of course, if there are any significant changes in your vision, but otherwise it should suffice to check your condition every six months or so.”

I was perfectly happy to accept the opinion of the two ophthalmologists that it was not necessary to shoot a laser beam into my eye. The semi-annual checkups seemed quite adequate, thank you very much.

Six months ago, the checkup proceeded without incident. This month, however, there was some additional excitement. The ophthalmologist ushered me into an examining room that sported an imposing piece of electronic scanning gear.

“It's brand new,” she told me. “We can now do better and more detailed scans than ever before.”

I sat down in front of it with my blearily dilated eyes and followed her directions to stare into the bright lights. A few seconds later, the color inkjet printer attached to the equipment spit out a detailed scan of my left retina.

“See that?” the ophthalmologists asked me chirpily, obviously still enjoying the novelty of her new diagnostic gear. “It shows you as clear as could be that you have an accumulation of fluid behind your retina. I'm going to refer you to the retinal consultant again and you can show him this printout.”

I was not as bubbly about the bubble as she was—in fact I was unnerved—but I dutifully agreed to see the retinal specialist the next week. In the meantime, I noticed that the scan was labeled with xy coordinates to identify the location of the cross-sections: 272 for the x coordinate on one graph, 8 for the y coordinate on the other. That, of course, captured my attention.

On the day of my appointment with the consultant, I put a brave face on things and shared the eye scan with my calculus class. The students were duly impressed (or at least were kind enough to pretend to be) by this example of xy coordinates at use in the real world. They passed the scan around and commiserated with me. One of them asked what was going to be done.

“Oh, I'm just going in for a consultation and second opinion. No one has decided yet to shoot a laser into my eye,” I finished, a bit weakly. The students favored me with sickly smiles.

I reported to the retinal specialist's office and endured the customary two-hour wait till it was my turn to see the man himself. I gave him the printout from my ophthalmologist.

“Oh, yes,” he said. “Yes, yes. That's quite a bit better.”

The bubble is a good thing?

“Huh?” I said, articulately.

“The fluid pocket is shrinking,“ the doctor replied. “That means we made the right decision in not intervening. Your problem is taking care of itself.”

“Um,” I said, suavely. “The bubble was already there last time?”

The consulting ophthalmologist seemed just a bit puzzled. “Hmm? Oh, yes. But this time your eye doctor was able to give me her own scan. Last time you were here I had to do it myself.”

And somehow managed not to mention it to me.

“This fluid pocket is definitely smaller than the one we saw a year ago,” he concluded.

“Oh,” I said, brightly. “That's good news.”

“Yes,” agreed the doctor. “Just see your regular eye doctor in another six months and we'll continue to watch your progress.”

The bubble was not new. The bubble had been there a year ago. The bubble was smaller now. I was happy. Sort of. I was also muttering a bit to myself as I left the consultant's office and walked out into the overcast afternoon. To my dilated pupils the sky was as bright as a laser blast, but I put on my Joe Cool sunglasses and headed home.

It was a good day, I told myself, so stop grousing.


By the way, after I showed my calculus students the scan of my eye and the utility of xy coordinate systems in medicine, I returned to the math offices and found one of my colleagues at his desk, his office door left incautiously open. I could not resist sharing with him an account of what I had just done. He perused the eye scan judiciously, his lips pursed and his head slowly nodding.

“That's very interesting,” he said. “Nice job. I'm sure your students were impressed.” He paused for a beat, then looked up at me. “I think I have some good news for you,” he continued. “My wife volunteers some time each week at a local animal shelter. When you start wearing an eyepatch, she should be able to get you a parrot to wear on your shoulder.”

Sugar versus salt

The bad guts saga

The perky medical assistant handed me an instruction sheet and a large bottle containing a viscous solution.

“This is your prep,” she said cheerfully. “Follow the instructions carefully the day before your exam.”

I looked at the bottle of magnesium citrate and then back at the aide.

“No,” I said.

The doctor's assistant froze in place with a stunned expression on her face. She was amazed to the point of speechlessness.

After several seconds of complete bewilderment, she found her voice again.

“You have to follow these directions or the doctor can't do the test!”

I brandished the bottle at her.

“Sorry. I am never chugging a gallon of magnesium citrate solution again. It's grotesque and revolting. I want the sodium solution instead. I tolerate it well and that's acceptable. This is not.”

She hustled off in pursuit of the doctor. I was obviously not going to be cooperative and she had no authority to change the instructions she had dutifully passed along to me.

I hadn't just fallen off the turnip truck. I'd been here before. Many times, unfortunately. As someone who had encountered colitis for the first time as a teenager, I had long since made the unpleasant acquaintance of the one-eyed snake used to perform colonoscopies. While I accepted my doctor's insistence on regular exams to monitor the condition, it drove me crazy that there was no more certain way than a colonoscopy to spark new cramps and pains. Quiescent periods of ease would come to an abrupt end and I'd suffer for days or even weeks after each exam. The consequences were not conducive to making me a compliant patient.

It took a few minutes, but the aide eventually returned. A sheet of paper was in her hand and the stunned expression was still on her face. She handed me the paper, which was a bad nth generation photocopy of an old typescript. The magnesium citrate instructions had been a modern Times Roman document (probably formatted in Microsoft Word). What I was now holding was clearly descended from an original that had been rapped out on a typewriter in monospaced Courier. At least it was on paper rather than a clay tablet.

“The doctor said you could follow these instructions instead. I found it in our files.”

The instructions for the magnesium citrate had told me to guzzle down a gallon of the sticky-sweet solution, plus many additional glasses of water to wash it down. These old instructions told me to chug three ounces of phospho-soda, in two separate doses of 1.5 ounces, taken hours apart. Easy! (By comparison, anyway.) Phospho-soda had apparently fallen out of favor with my physicians, but not with me.

This all happened maybe ten years ago. I see from searching the Internet that phospho-soda may have undergone a renaissance since my display of stubbornness. The most “popular” glycol-based preps of today, however, still appear to be part of the high-volume family of gut-flushers, even if they now sport cutesy names like GoLytely. One new twist is the addition of an anti-nausea medication to prevent the patient from upchucking the nasty, syrupy solution. Perhaps that would have spared me the heaves and throat cramps of the one time I drank a gallon of laxative. That would be a slight improvement. But no matter. My heart belongs to phospho-soda. Or at least my colon does.

Continuing indoctrination for nurses

The papal nurse will see you now

In the continuing observance (celebration?) of the fortieth anniversary of the papal encyclical Humanae Vitae, the St. Anthony of Padua Institute and the Diocese of Oakland are sponsoring an all-day conference on August 9 at St. Mary's College in Moraga, California. No, I won't be going. But if I were a nurse, I could get continuing education credit by attending. That's right: The California Board of Registered Nursing has rated the conference as being worth 4.6 contact hours for purposes of continuing education.

Ain't that a kick in the head?

Let us at least consider the possibility that the Humane Vitae conference will indeed be educational and not simply a day-long indoctrination on Catholic birth control dogma. After all, nurses have many Roman Catholic patients and one can imagine a secular purpose in learning about the things Catholics believe so as to understand their concerns better. We could list it under “cultural sensitivity,” which I'm sure is a good thing. Right?

Abandon all hope. Here are some highlights of the conference program:

After 9:00 mass (with a bishop!), Janet Smith delivers a plenary address on the Connection between contraception and abortion. She's followed by Christopher Kaczor, whose topic is Humanae Vitae explained and defended. After the lunch break, the final plenary address is Joel Barstad's presentation on Primacy of conscience. (Since many Catholics cite personal conscience as an excuse for using birth control despite Church teaching on the issue, I'm guessing Barstad is going to explain why it's a sin to substitute personal conviction for Church dogma. [But Kevin Keith has a better guess than mine; see the comments.])

If you haven't had enough by this point, just look at dessert. You have three choices for breakout sessions: Choose either Dr. Mary Davenport's Seven myths regarding “reproductive” technology and women's health (held in, of all places, Galileo Hall!), Father Brian Mullady's talk on the Theology of the body (no doubt based on John Paul II's writings on the subject), or Dr. Raymond Dennehy on From contraception to abortion to the death of democracy. (The Catholic Church is understandably really big on democracy and would hate for it to die and be replaced by any kind of autocracy.)

If that's not 4.6 contact hours of continuing education, it's at least an endurance contest. Strangely enough, it's probably the sort of thing I could sit through quite easily (assuming comfortable seats), even though I would undoubtedly have to master occasional impulses to yell “Are you kidding me?” at the speaker. I'm not by nature a disruptive person. (My mildness notwithstanding, I imagine it would incite chaos if I wore a Pharynguloid T-shirt. Are there such things? Just a thought. In any case, it sounds more like a coat-and-tie affair.)

Apparently the California Catholic Women's Forum is the organization that is certified by the California Board of Registered Nursing as a provider of continuing education. CCWF boasts Provider Number CEP 15002 and offers this course description for the Humanae Vitae conference:

Culturally conditioned views of human sexuality influence behavior and subsequent health care outcomes. New and emerging reproductive technologies reframe the connection between intercourse and pregnancy, and affect the marital relationship. This seminar is designed to give nurses the understanding of various views of sexuality and how these views profoundly affect sexual health, marital relationships, and the pursuit or avoidance of fertility.

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As someone whose scholarship resides in other fields, I cannot say definitively whether the announced conference schedule is likely to meet these course objectives. I'll admit, though, that I am struck by the phrase “understanding of various views of sexuality.” One can be relatively confident in concluding that the various views will indeed be discussed—and conveniently labeled as right or wrong in terms of their agreement or disagreement with Church teachings. That's just a tiny bit problematical, isn't it?

And yet this somehow cleared the bar established by the California Board of Registered Nursing for acceptable course content. Perhaps it's classified under “Cultural and ethnic diversity,” because I'm pretty sure it's out of the running for “Theoretical content related to scientific knowledge.”

Oh, well, if nurses can get continuing education credit for Therapeutic Touch voodoo, why not for training in Catholic doctrine? One shouldn't discriminate on the basis of race, color, religion, sex, sexual orientation, marital status, national origin, disability, age, or wackiness. That would be wrong.

Touched in the head

Mainstream mysticism

Remember Emily Rosa? Lots of people would probably rather you forget. Emily was only nine years old when she devised an experiment for her local science fair. Twenty-one practitioners of “therapeutic touch” participated in Emily's double-blind study of their ability to detect the energy aura that supposedly emanates from every living human's body. Despite the practitioners' confidence that they could detect and manipulate such supposed human energy fields, the results were no better than random chance. They could not tell the difference between human presence and absence when screened from visual cues.

Emily won a blue ribbon in her science fair and her research study was later published in the Journal of the American Medical Association, making her the youngest person ever to have a JAMA publication to her credit. Thereafter, of course, the practice of therapeutic touch was thoroughly discredited and its practitioners slipped silently away into obscurity.

Are you kidding? Scientific refutation never truly discourages the pseudoscientist.

Therapeutic touch is bigger than ever. The currently preferred term is “healing touch.” It's an extremely popular technique among nurses who can actually get continuing education credit for taking courses in this imaginary therapy technique. The San Francisco Chronicle ran a big story on healing touch on the front page of its B section this morning. Stanford University is taking healing touch therapy seriously enough to embark on a three-year clinical trial of its efficacy. The results will be out in two more years.

Are you psychic enough to predict the results? I suspect that healing touch will prove to be no more effective than a placebo. That, nevertheless, will be enough to produce shouts of triumph from the imaginary medicine community. After all, it could be working. What more do you need?

Here are some excerpts from the Chronicle article:

Energy therapy: Where mysticism meets science

By Carrie Sturrock
Chronicle Staff Writer

Monday, May 26, 2008

Anne Broderick believes she can use her hands to alter the energy fields of others to help them heal, taking away fatigue, stress and nausea.

A clinical trial at Stanford University aims to prove it. The university is testing whether an energy therapy called Healing Touch can reduce the debilitating effects of chemotherapy on breast cancer patients.

It's the juncture where touchy-feely New Age mysticism meets hard science.

Healing Touch is a noninvasive energy therapy program founded by a registered nurse in Colorado in 1989. Its following has spread nationwide. Advocates stress that it isn't a cure but a way of easing the stress, fatigue and nausea of radiation and chemotherapy.

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It's “energy therapy.” Could someone tell me what form the “energy” takes? Can you measure its strength in joules? (The answers are “No” and “No.”)

Ms. Broderick is a “Healing Touch certified practitioner.” That basically means taking some course work from the people who invented and promote therapeutic touch. You pay your tuition of $300 or so and sign up with the Healing Touch Program: “The Healing Touch Program offers a series of energy-based therapy classes in which students use a variety of hands-on techniques that facilitate energy balance for wholeness within the individual, supporting physical, emotional, mental and spiritual wellbeing.” Simple as that.

Healing touch is offered at several major medical clinics. The provider at Stanford is Healing Partners, the director of which is one of the investigators in the clinical trial.

Healing Partners has paired more than 100 breast cancer patients with Healing Touch providers since the free program began three years ago at Stanford.

That success prompted its director, Kathy Turner, a registered nurse, to prove its effectiveness in a randomized, controlled clinical trial that started last year. As all undergo chemotherapy, one group of breast cancer patients receives Healing Touch for 20 minutes, a second group listens to a relaxation tape, and a third gets nothing. Researchers haven't yet analyzed the initial data.

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Turner gave the Chronicle a summary of the notions behind healing touch:

“It's based on the belief that our bodies are surrounded by a field of energy and our bodies themselves are a denser form of energy,” Turner said. “The belief there is that once the body's energy is cleared and balanced, our bodies have the innate capacity to heal themselves.”

The underlying technique is age-old, advocates say, and intends to balance and align people's energy fields so they become “whole in body, mind, emotion and spirit”—although no one knows quite how it works.

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Or even what the words mean. Denser form of energy? Balance? Align? Age-old? (Therapeutic touch was invented in 1989 by the late Janet Mentgen,RN.)

Although Anne Broderick presents herself as originally skeptical in an interview with Palo Alto Online (“I thought it was pretty 'woo-woo' stuff”), she now has the faith of a true convert:

Broderick, a former corporate executive turned psychotherapist, provides Healing Touch to Lydia Li every week. Both survived breast cancer and took part in Healing Partners at Stanford.

Earlier this month, Li arrived at Broderick's Palo Alto office with shoulder pain and a headache. She lay on a massage table, and Broderick covered her fully clothed body with a white sheet. Broderick, 69, then silently told herself, “I set my intention for the highest good,” and began methodically touching Li to the sounds of running water and quiet music, occasionally sweeping her hands above her. At times, she firmly held a foot, knee or wrist. At others, she seemed to play an imaginary piano on Li's back.

Often, Broderick begins sessions by holding a crystal (although she said a “lifesaver on a string” would work just as well) 4 inches above Li and watches it circle over the seven chakras—energy vortices—that run along the length of the body. Clockwise is a good sign. No movement or one that's counterclockwise means the person could use some help getting healthy energy flow, she says.

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Chakras? I think we just found the “age-old” part. Healing touch contains a healthy dollop of repackaged Eastern woo. Deepak Chopra would be proud. (Or jealous.)

The Chronicle illustrated its news article with a large photo of Broderick in action, waving her hands over Lydia Li. Thanks to the skills of photographer Kat Wade, Broderick is captured in a nimbus of light. You want an aura? Move around in front of a light source while the practiced eye of a professional photographer captures the perfect moment. It's all in the hands.

Of the photographer.

Urinetown

A splash of color

This is a tale of modern medicine, marksmanship, and men's restrooms. It is a true story, spanning decades, full of angst and self-discovery. It is a sad story, suggesting that some of our most cherished goals may be out of reach.

When I was young, my parents would sometimes bundle me and my siblings into the car and whisk us off for a family outing into the Sierra Nevada. We'd visit places like Yosemite, Balch Park, or Camp Nelson (where some friends had a cabin). One evening we found ourselves gathered around a big bonfire outside the Camp Nelson lodge, where some impromptu entertainment had sprung up. Campers, cabin dwellers, and day-trippers sat at picnic tables and listened to a large-voiced woman with a guitar and a couple of accompanying percussionists. A cow-bell may have been involved, too. I don't recall. I do remember the woman's headgear: a peculiar assemblage of Budweiser cans that had been snipped apart with shears and woven together with yarn into a charming chapeau. She announced her next selection, which she said was a tribute to her husband: “The title of the song is Shorter than You Think or ... Tacky Toilet!” The crowd chuckled at her bathroom humor and settled in to listen to her country-western serenade to her spouse's poor marksmanship.

Now fast-forward about forty or forty-five years. The original urinal in the men's restroom of the college's new faculty building was a source of dismay and controversy. It was small and set low to the ground. The tile floor in front of it was always damp and smelly. The building was brand new, but some parts were aging fast. A few of the male faculty members embarked on a great quest to replace the inadequate plumbing fixture. As quests go, it was no Holy Grail, but at least it proved feasible. A new, more generously endowed urinal eventually replaced the deficient original. A new, more sanitary day was about to dawn.

Except it didn't, really. Although the new StraddleMaster 9000 seemed more user-friendly and offered a much more generous target, the Camp Nelson contralto could have sung its praises with the same song she had once dedicated to her husband. Our hopes had been raised for naught. What is it about urinals and male marksmanship? When were we infiltrated by the gang that couldn't shoot straight?

Then it came to pass that my eye doctor summoned me for a medical test. She was keeping an eye on a scar on my left retina, which she suspected might be the vestige of a small hemorrhage. For the sake of due diligence, although no bleeding was apparent, she ordered a fluorescein test. While the assistant keeps a camera focused on your retina (and blinds you with bright light), the doctor injects a fluorescein solution into a vein. Fluorescein is a bright dye that quickly makes its presence known as it works through the blood vessels throughout your body, including those in the back of your eye. The assistant takes multiple photographs, first of one eye, then the other, going back and forth at intervals until she's captured all the images the doctor wants.

I came through the process like a champ, merely blinded by the light and blinking at the purplish after-images that seemed to hover before my dilated pupils. When the doctor announced that the test was over and I was free to go, I strolled over to the restroom to check on one of the examination's known side-effects. Yes, indeed, my urine was now a brilliant yellow color. Shockingly bright. It would take many hours for the fluorescein to be flushed out of my system. In the meantime, my urine had become an intense yellow dye. Remember how your mother always wanted you to wear good underwear to the doctor's office? Well, if it's a fluorescein test, consider digging out your rattiest.

A few hours later, the dilation of my eyes having receded to the point where I felt competent to travel, I went into my office at school. After some time there, I had occasion to visit the men's restroom. This was a natural consequence of my elevated fluid intake, since I was motivated to drink copious amounts of liquid till the fluorescein was gone. At a minimum, however, the dye would remain in my body a full day, so it made its presence very conspicuous when I ambled up to the StraddleMaster 9000. It was a sobering experience. Even perfect aim could not prevent errant drops from ricocheting all over the porcelain fixture. The dye did not lie.

It was worse than I could have imagined. I remembered the remarks of a colleague who had scoffed at the crusade to replace the original urinal. He said it wouldn't do any good and commented that guys who regularly wore shorts would understand. As one who has favored long pants for fifty years, I shrugged it off at the time as merely a mildly repulsive remark. Now I knew it was true.

The horror.

It took more than a full day for matters to return to normal. I claim not to have been scarred by the experience. Nevertheless, I was not pleased to hear my eye doctor suggest it would be nice to do a follow-up fluorescein test in six months. Something to look forward to.

At least there's a happy ending. The ophthalmologist says she sees no major problems in my slightly scarred eye, so the occasional exam is all that is indicated at this time. Also, the brilliant yellow dye washes right out in the laundry. Nothing was destroyed except my self-respect.

Doctor Big Brother

He works for the Kaiser

Are you familiar with the Kaiser? Kaiser Permanente is a huge health maintenance organization that serves California and several other states. Most of my colleagues in education have Kaiser as their health plan, especially since employees experience more out-of-pocket expense with other plans. Kaiser costs less because it controls more: You see Kaiser doctors at Kaiser facilities. While it's possible at some point to get a referral that takes you outside the Kaiser system, that is not standard operating procedure.

Clients of Kaiser sometimes grouse about the limitations of the system, but most people seem content with the trade-off of personal choice in favor of cost control. That is, after all, one of the guiding principles of HMOs.

Kaiser Permanente works hard to keep its name before the public and to encourage people to opt for its services when selecting the provider of their employee health benefits. Currently Kaiser is running a series of television advertisements that use “Thrive” as a linking motto. The Thrive campaign is nothing exceptional, featuring the usual healthy, well-scrubbed people who show no signs of needing any special medical attention. We all understand that we're supposed to link the images of healthy-looking people with enrollment in Kaiser. I get it.

What I don't get is why Kaiser thinks its “Entourage” ad will give people warm feelings toward the company. This recently revived spot (originally created in 2004) shows how Kaiser personnel will follow you around all day, intervening in your personal choices and taking control of your life. Isn't that what all of us want? A cardiologist and an internist check a guy's blood pressure and take his vitals while he's trying to participate in a business meeting. A dietitian sneaks up during lunch and swaps the person's chicken dinner for a salad. An optometrist hovers over that person while he puts on his glasses. During the commute home, a physical therapist in the back seat mauls the guy's shoulders while he tries to drive. Then, when the fellow gets home and greets his wife, the entire entourage follows the couple upstairs and a smiling pediatrician waits outside their bedroom door as they presumably work on conceiving a child. Isn't that cozy? Doesn't that mirror your fondest dreams?



The commercial notes that “You don't have to be famous to have an entourage.” Given how much we all hope for an entourage of our own, Kaiser has certainly homed in on a vulnerable point. The next time you're making love to your partner, consider how much happier you would be if a grinning Kaiser physician were just on the other side of the door. Bedside manner has taken on a whole new meaning with Kaiser's entourage coverage.

Prisoners of science!

Isn't willow-bark tea enough?

Modern medicine is unfortunately rather corporate and impersonal. A lot of this has to do with our nation's unwillingness to take health care seriously, leaving it as a patchwork quilt of profit-driven HMOs and haphazard public-sector programs. It's regrettable and not likely to be fixed any time soon.

There's another aspect, though, thrown into high relief by paranoid outcries like a letter in today's San Francisco Chronicle. When the newspaper ran a human-interest story about a poodle who spends time cheering up young patients at UCSF's Children's Hospital, one reader's reaction was to issue a denunciation. Apparently science and medicine are evil. Or cruel. Something like that.

Spare us cutesy stuff

Editor — I cannot get your May 19 story about Izzy the poodle at UCSF out of my mind.

Could The Chronicle editors please spare its readers this sort of cutesy, upbeat reporting, where a happy face is painted on a tragedy?

The idea that a dog “brings joy to patients” is negated by the reality of the heart-rending accompanying photos of suffering children held hostage to illness, science and the medical-pharmaceutical industry.

Jane Q. Kennedy
San Francisco

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I have no reason to question Ms. Kennedy's sincerity, which rings out from her hand-wringing prose, but what would she prefer to see? Should the young cancer patients be sipping herbal tea instead while sniffing aromatherapy candles and listening to Enya? That would be the very picture of tranquility.

Of course, they'd die.

The sad truth is that many of these kids will die anyway. Leukemia killed two of my cousins, despite the best that modern medicine could do at the time. One of them went very quickly. The other gained an additional ten years of life before a recurrence took her away from us. Both had difficult times during treatment and chemotherapy. I wish they could have been spared that suffering. Ms. Kennedy appears to believe that the suffering of juvenile patients is a pointless tragedy, motivated perhaps by the cupidity of “science and the medical-pharmaceutical industry.” What a nasty world she lives in. I suppose the doctors are in on the money-making conspiracy. Perhaps they giggle in the break room at the naïveté of their trusting patients and wink at each other. How clever of Ms. Kennedy to call them out.

Without claiming that science is always perfect or that the pharmaceutical industry always chooses people over profit, I will say that people like Ms. Kennedy are part of the problem. Her letter is a simple-minded bleat of anguish that offers nothing to anyone. I hope it at least made her feel good.

Jesus H. Christ, M.D.

Tell Dr. Jesus where it hurts

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“Good morning! I'm Dr. Sawbones and I'll be doing your surgery this afternoon. I thought it would be a nice thing if we spent a few minutes praying to Our Lord and Savior Jesus Christ for a good outcome to your operation. I also wanted to make sure that you've accepted Christ into your heart, because if anything should go wrong, your only path to eternal happiness in heaven is through the saving blood of our dear Savior. Do you have Jesus in your heart?”

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Pray tell, how would you react to that? Dr. Michael Wilkes, professor of medicine at the University of California, Davis, says it's increasingly likely for hospital patients to be confronted by such an “opportunity”:

Several patients recently complained about a surgeon who regularly invited his patients to pray with him before surgery. The patients said they were never forced to pray, but some complained that they felt that if they refused to pray, it might insult the surgeon who was about to operate on them. Others felt it would be bad luck not to pray when invited by your surgeon—even if they didn't believe in prayer.

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Although I share the concerns reported by Dr. Wilkes, I prefer to take a positive point of view. If your overtly religious surgeon were to learn that you are a nonbeliever, than wouldn't he strive mightily to preserve your life so as to have further opportunities to evangelize you and perhaps redeem another soul (that is, the soul he imagines you have)? But perhaps I am too optimistic and he would just as soon consign you to the condign punishments of hell. Only his professional pride would save you in that case.

Dr. Wilkes contributes an Inside Medicine column to the pages of the Sacramento Bee. The paragraph I quoted comes from the February 25, 2007, installment, which carries the title On care—and prayer. He points out that medicine and religion often intersect, but questions whether religious doctors have any business bringing their religion into their interactions with patients. Is there supposed to be any benefit to praying with one's patients?

There is a growing number of those in the medical community who believe physicians should both inquire about a person's religious beliefs and promote religion as a road to improved health. Advocates have been successful at encouraging many medical schools to offer education on religion and spiritual health.

Proponents cite figures suggesting that the American population, and even a majority of scientists, are highly religious, believe in God, and if sick would want religious support. They further cite studies that show that religious activity is associated with improved health and longer life.

It could be argued, however, that many of these studies are biased and flawed. Those who are religious often engage in radically different lifestyles than the non-religious. Some could say that it's the lifestyle, rather than the religion, that contributes to any health benefit. Further, research on religion regularly assumes a Christian context that ignores the large diversity of other beliefs and spiritual thinking.

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Attempts to prove the efficacy of prayer have always failed —at least whenever competent scientific standards have been applied to the investigations. Dr. Wilkes suggests that his fellow physicians refrain from intruding any further than necessary into a patient's personal life.

One might ask, how can bringing religion into medical practice be bad? Here, I think, there is a slippery slope. I worry that doctors may find it difficult to refrain from religious discussions or promotion of religion. Promoting or endorsing religion at a time of illness has the potential to stir intense feelings of conflict, guilt and anxiety for many people. For some, the religion discussion may even imply self-blame for not having led a more religious life....

Doctors should ask sick people if they'd like to speak with a spiritual leader, and if they do, our task is to make arrangements for such a visit. We should ask healthy patients if they are religious or spiritual, just as we ask if they are allergic to any medications. In both cases, the information may be helpful in the future.

But to use our position to suggest sick people pray or attend church is beyond our expertise and takes us from a medical agenda to a personal and private agenda. The medical profession ought to attend to matters of health and illness, and refer sick people to colleagues in the clergy.

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Yes—provided those sick people actually want to talk to members of the clergy. With that proviso, I'd say Dr. Wilkes has written a good prescription.