Wednesday, April 20, 2016

Review: Bad Faith: When Religious Belief Undermines Modern Medicine by Paul Offit

Bad Faith: When Religious Belief Undermines Modern Medicine by Paul A. Offit (Twitter)

Dr. Offit reviews a series of incidents in which children died of treatable illnesses due to the pursuit of their guardians or parents of spiritual healing through supplication in lieu of standard medical practice. He then gives an interpretation of Christianity which rejects spiritual healing as a substitute for medicine. Then he provides an overview of the historically recent development of state protection of children from abuse by their parents and guardians. Finally, he discusses efforts to proscribe and punish parents and guardians who fail to provide standard medical care to the children in their care and resistance by some religious groups which led to religious exemptions to these anti-neglect laws.

The organization of the book makes for a logical progression to Dr. Offit's call for an end to all religious exemptions to laws designed to protect minors.

The variety of USA religious groups which rejected standard medical treatment in favor of supplications surprised me. And while I knew that most pre-progressive era law systems ignored abuse of guardians towards their children, I did not know anything about how that changed in the United Kingdom and the USA. I also didn't realize how important developments in radiology in the 1950s were to exposing child abuse.

Muslim bioethicists, health care practitioners and counselors/imams should read this book to understand better the dangers which occur on the periphery of alternative, holistic and spiritual treatment modalities. The Journal of the Islamic Medical Association of North America has published numerous articles exploring "Prophetic Medicine" and "Islamic Medicine," While most of these articles supported standard medical practice, they may not have expressed with Offit's urgency how easy it is for charlatans and con artists to prey on ignorant and vulnerable people in matters of religion and disease.

Some of the most valuable passages in the book are Offit's analysis of Larry Parker, who, after hearing a faith healer speak in his church, decided to stop administering insulin to his eleven-year old son Wesley, who died after several days of suffering. This analysis is based on published reports and the two books Parker has authored since his conviction, We Let Our Son Die and No Spin FaithRejecting Religious Spin Doctors. Parker may have suffered from Narcissistic Personality Disorder,
defined by the [Diagnostic and Statistical Manual of Mental Disorders] as a "pervasive pattern of grandiosity, in fantasy or behavior, a need for admiration, and a lack of empathy." When [Parker's pastor Nash] pleaded with the Parkers to take Wesley to the hospital, Larry said, "God has given me the faith." After Larry was arrested, he likened himself to Paul the Apostle. When Larry asked God to set him free from prison, God talked to him. When Larry wondered whether he should fast, God sent him a delicious helping of sweet potatoes. ... To Larry, God was like the CEO of his own personal "make a wish foundation," ready to reward his faithfulness whenever asked; like many believers in faith healing, he had presumed to know the mind of God. (pp. 55-6, emphasis in original)
Imams and preachers need to steer people away from these kinds of temptations and misinterpretations, assuming the religious functionary hasn't succumbed to them himself/herself.

Another great point Offit makes about faith healers is that they tend to cling to some passages of scripture with their sectarian interpretation, but they don't use the same epistemology for other passages of scripture.

I came into the book extremely suspicious of government attempts to force healthy behavior. Offit's evidence that passage of laws did result in changes in behavior made me more open to this idea. It seems that ending religious exemptions to child neglect laws results in fewer people believing in faith healing without standard medical practice. Law establishes value.

Nevertheless, I'm still reluctant to imprison neglectful parents and strip them of guardianship of their surviving children. I wish there was a way for them to continue raising their children while ensuring that they receive standard medical treatment. In practice, this has proven difficult since many of these parents, while on probation which specifies standard medical treatment for their children, continue to practice faith healing exclusively. Some of these parents have lost two or more children to preventable disease.

To me, the cases most calling for government intervention are those involving infectious diseases, where other children are placed at risk by the actions of faith-healing parents. Certain vaccines are not administered until children reach a certain age, and maintaining herd-immunity is important, as there will always be some children who are not vaccinated, either by choice of the parents, issues of access or contraindication.

While it may be outside the scope of his book, I think Offit neglects some of the structural reasons why faith healing remains popular. Large segments of the USA population can't afford standard medical care. Standard medical care doesn't have great results with some of our chronic diseases such as diabetes and dementia. Being on the patient side of standard medical care is often frustrating, disempowering and humiliating. So it's not far-fetched that adults are trying to treat their children outside the health system. The obvious retort to this is that the diseases which kill children are actually the ones which our health care system, with all of its flaws, actually does a good job addressing.

Another problem is the undermining of science by special interest groups and of government by oligarchy, as exposed by Cablegate, the Afghanistan war logs and the Panama Papers. People don't believe scientists and government officials when they say vaccines don't cause autism.

Finally, major segments of public and private education fail to provide students with the tools necessary to evaluate claims of faith healers and Ponzi schemers alike, although it should be noted that many educated and high-performing individuals follow them.

Updated April 21, 2016: The book engendered a lively discussion at our local Americans United for Separation of Church and State book club, mainly because most other participants thought the value of the child's life was greater than the value of protection of an individual's conscience (i.e. religious freedom of parent to impose will on child) and/or a guardian's right to raise a child as he/she sees fit. In particular, a person who had worked in pediatric nursing for decades was most adamant that, if a parent's refusal to provide standard medical care could result in the child's death or serious injury, the state must compel treatment of the child, and, if injury or death occurred, punish the guardian and strip him/her of further parental rights.

Others believed that no law should allow religious exemptions, although people acknowledged we have numerous examples of that in our existing laws unrelated to medical neglect.

Participants talked about a slippery slope to which religious exemptions might lead: underage marriages, physical abuse ("spare the rod, spoil the child"), pawning into slavery, etc. They did not share my concern of the slippery slope in the other direction, where the state takes away parental rights for suboptimal parenting.

I brought up two examples of Muslim religious and quasi-religious practice which some state may try to restrict: male child circumcision and first cousin marriages. The first practice is considered religiously obligatory and is, to my knowledge, nearly universally practiced. The second is considered permissible, and its practice varies widely. While the United States is currently circumcision-friendly, other industrialized nations are not, and more voices in the United States are calling for circumcision on minors to be considered an unnecessary or harmful medical procedure performed without proper consent. While many US states don't ban first cousin marriages, popular culture considers it incest and considers children born from first cousin unions prone to genetic disease.

Discussion participants differed in their assessment of the dangers of these practices, with most believing that the state should not intervene because the risk to minors of death or serious injury was low. I remain concerned that removing religious exemptions will open the door to government intervention in lives of parents of marginalized groups, regardless of the actual harm done to the children.

One participant advocated the position that, if exemptions were to be made at all, they should be available for the religious and non-religious alike.

Finally, the pediatric care professional was opposed to the MMR vaccine (but supported each vaccine administered separately) and to Gardisil, the vaccine for the human papillomavirus (HPV). The professional believed the safety of these two vaccines was in question and believed that parents who did not vaccinate their children out of safety concerns should not face any state sanction. The discussant waffled somewhat on whether the children should be allowed in public school if they did not have the MMR vaccine or its components.