Modes of Faith in Medicine
Alexis Carrel: A Life in Search of the Integration of Medicine, Science, and Faith
Jacek L. Mostwin, MD, DPhil, John Hopkins School of Medicine
Alessandro de Franciscis, MD, Comité Médical International de Lourdes
Hubert Guigou, MA, Bureau Medical de Lourdes
Alexis Carrell was the first medical researcher from the United States to be awarded the Nobel Prize in Physiology or Medicine "in recognition of his work on vascular suture and the transplantation of blood vessels and organs" which opened the possibility of organ transplantation. Few, however, know of his origins or the struggles between faith and medicine that occupied his medical and scientific career.
Carrel, born into a prominent family in Lyon, educated by Jesuits, gradually adopted the agnostic positivism and rationality of his time. His initial surgical work was completed just before he joined a pilgrimage train bound for the Shrine at Lourdes to replace an ailing colleague in 1902. There he witnessed the unexplained, complete reversal of tuberculous peritonitis, after immersion in the waters of Lourdes, of Marie Bailly, a woman whom he had examined and whose death seemed imminent. His life was transformed by this experience and news of it appeared in the press in Lyon: members of the faculty and the governing boards of all major hospitals - quite hostile to religion - shut their doors to Carrel's career. His application for hospital privileges was denied. In 1904 he was forced to emigrate to Canada and soon offered a laboratory by the University of Chicago where he continued work on organ transplantation. He corresponded with Dr Boissarie, chairman of the Lourdes Medical Office, regarding Bailly's healing and the relation between healing and prayer. He became known internationally.
In 1905, Harvey Cushing invited Carrel to Hopkins in Baltimore to present the first ever results of organ transplantation in animals. He was introduced to Simon Flexner and moved to the New York Rockfeller Institute in 1906. In 1912 he was awarded the Nobel Prize to great acclaim in the US.
He was offered citizenship but preferred to remain a son of France where during WW I, he developed antiseptics with Henri Dakin. After the War, Charles Lindeberg collaborated as his engineer at the Rockfeller's Institute. His interests in eugenics made him a controversial figure in post WW II France. All his life, he struggled to integrate his faith with his scientific curiosity, ever investigating the « power of prayer » and eventually publishing his masterpiece « Man, the Unknown» (1935). His final work « La Priere » (1944) was his spiritual testament. After a lifetime of searching, he concluded that: « Rather than a simple recitation of formulas, true prayer represents a mystical state in which consciousness is absorbed in God. This orientation is not intellectual in nature and remains inaccessible to philosophers and scientists alike. ...But in this, God ... makes himself so abundant to the man who loves, and hides [from] those who seek only to understand ».
In November 1944 Alexis Carrel died in Paris at peace with God and his Christian faith. A few years after his death, Anne, his widow, found the hidden diary of those dramatic days at Lourdes that were published posthumously, unedited, in 1949 as «Voyage à Lourdes».
Trust, Faith, and Transformation in Central Appalachia
Chelsea Jack, BA, The Hastings Center
Remote Area Medical (RAM) – a roaming free health care clinic created and managed by Stan Brock for the poor and uninsured – hosts an annual clinic each year at the Wise County Fairgrounds in Southwest Virginia. Nearly 2,000 people from Central Appalachia travel to the fairgrounds and camp out in their cars over a weekend waiting to receive dental care, preventative screenings, new eye glasses, and other health services. They wait in horse stalls, in the rain, under tarps, and in crowded trailers – and they are intensely grateful.
In July 2014, I attended the RAM clinic in Wise, VA as an interview consultant for a Duke University study on preventative screening usage among RAM patients. Virginia Governor Terry McAuliffe had traveled to Wise to meet and acknowledge the clinic patients struggling to access affordable health care in Central Appalachia. In part, McAuliffe was there to discuss Medicaid expansion; but, for many complicated reasons that this paper aims to address, his words fell on unwilling, even hostile, ears. A woman at the back of the audience shouted to interrupt him mid-speech:
“We know Jesus. And we know Stan Brock. Who are you?”
“I’m the governor,” McAuliffe replied.
Disparities in health outcomes have plagued Appalachians for far too long, and those disparities continue to feed distrust of federal health care reform. In Virginia, lawmakers reinforced distrust among their constituents this past year when the state forfeited billions in Medicaid expansion funds, excluding 400,000 poor residents who would have qualified for Medicaid coverage. Non-Appalachian residents look on with confusion and puzzle over (what is stereotyped as) the political backwardness of Appalachians who vote against the health care reforms that could serve their best interests, such as Medicaid expansion under the Affordable Care Act.
This paper investigates notions of trust and distrust in the context of health care reform in Central Appalachia. Drawing on womanist theologian Emilie Townes’ work, I examine resistance against health care reform. Though Townes focuses on African American health care in the US, I discuss how her concept of “communal lament” – a term signifying the processes of naming unjust consequences of the nation’s health care systems, seeking to repent, and then healing those injustices – might also apply to poor Appalachian residents. Their struggle to access affordable health care services in the face of socioeconomic barriers to equitable health outcomes is concretized by appeals to faith. Conversations with RAM patients helped me identify the relevance of trust and distrust, suffering, and transformation in the pursuit of an interrelated conception of how mind and body interact in Appalachian culture.
African Americans Rate "Having God's Help" as the Single Most Important Factor Affecting a Person's Ability to Quit Smoking: Results from a National Survey
Alexandra Shields, PhD, Harvard Medical School
Elyse R. Park, PhD, Harvard Medical School
Anthony Roman, MA, University of Massachusetts
Caryn Lerman, PhD, University of Pennsylvania
Anna B. Schachter, MPH, Harvard Medical School
Background: Smoking remains the leading cause of preventable morbidity and mortality, especially among minority and poor individuals. Approved cessation medications continue to be underutilized, particularly among Blacks. Emerging pharmacogenomic treatment strategies will offer improved quit rates by matching patients to the medication most likely to work for them, but fundamentally depend on smokers’ willingness to use medications to quit.
Methods: We conducted a nationally representative, random-digit-dial telephone survey of 2,400 self-identified white and Black Americans to assess lay beliefs about what most influences smokers’ ability to quit, how these beliefs differ among smokers versus nonsmokers, and across substances (nicotine, alcohol, cocaine). Measures assessing these beliefs were developed via focus groups, one-on-one interviews, cognitive testing, and pilot testing. Data was collected by the UMASS-Boston Center for Survey Research from 2008-2009. Multivariate models were fitted to assess individual characteristics associated with specific beliefs about quitting, the relationship between smokers’ beliefs and history of pharmacotherapy use, and the extent to which cultural patterns of belief persisted across substances.
Findings: We had 2059 respondents, representing a 40.1% response rate (AAPOR Method 4 formula), and 81.2% response among those we were able to reach. Fifty percent of Blacks, regardless of smoking status, believe “having God’s help” is the single greatest influence on smokers’ ability to quit (vs. 18% of whites; p<0.0001). fifty-eight percent of whites (vs. 40% blacks; p<0.0001) believe “willpower” is the greatest influence. only 3% of blacks and 7% of whites believe “medications or counseling” to be the greatest influence. these cultural patterns persisted in multivariate models controlling for self-identified race, age, sex, educational attainment, self-described religiosity, health status, and smoking status; and across substances. among smokers (n=397), those who rated ‘having god’s help’ (or: 0.20; 95% ci: 0.36-0.78; p=0.023) or ‘willpower’ (or:0.20; 95% ci:0.20; 95%ci: 0.04-0.71; p=0.015) as the greatest influence were less likely to have ever used pharmacotherapy.
Interpretation: low pharmacotherapy use among smokers will become more salient as pharmacogenomic treatment strategies, which fundamentally depend on smokers’ willingness to use medications in a quit attempt, become available. unless smokers’ lack of willingness to use medication in a quit attempt is addressed, pharmacogenomic smoking treatment will greatly exacerbate black-white and socioeconomic disparities in the burden of smoking-related illness and death. spirituality may be an important, underutilized vehicle for engaging spiritually-motivated smokers to use medications in a quit attempt.
Jacek L. Mostwin, MD, DPhil, John Hopkins School of Medicine
Alessandro de Franciscis, MD, Comité Médical International de Lourdes
Hubert Guigou, MA, Bureau Medical de Lourdes
Alexis Carrell was the first medical researcher from the United States to be awarded the Nobel Prize in Physiology or Medicine "in recognition of his work on vascular suture and the transplantation of blood vessels and organs" which opened the possibility of organ transplantation. Few, however, know of his origins or the struggles between faith and medicine that occupied his medical and scientific career.
Carrel, born into a prominent family in Lyon, educated by Jesuits, gradually adopted the agnostic positivism and rationality of his time. His initial surgical work was completed just before he joined a pilgrimage train bound for the Shrine at Lourdes to replace an ailing colleague in 1902. There he witnessed the unexplained, complete reversal of tuberculous peritonitis, after immersion in the waters of Lourdes, of Marie Bailly, a woman whom he had examined and whose death seemed imminent. His life was transformed by this experience and news of it appeared in the press in Lyon: members of the faculty and the governing boards of all major hospitals - quite hostile to religion - shut their doors to Carrel's career. His application for hospital privileges was denied. In 1904 he was forced to emigrate to Canada and soon offered a laboratory by the University of Chicago where he continued work on organ transplantation. He corresponded with Dr Boissarie, chairman of the Lourdes Medical Office, regarding Bailly's healing and the relation between healing and prayer. He became known internationally.
In 1905, Harvey Cushing invited Carrel to Hopkins in Baltimore to present the first ever results of organ transplantation in animals. He was introduced to Simon Flexner and moved to the New York Rockfeller Institute in 1906. In 1912 he was awarded the Nobel Prize to great acclaim in the US.
He was offered citizenship but preferred to remain a son of France where during WW I, he developed antiseptics with Henri Dakin. After the War, Charles Lindeberg collaborated as his engineer at the Rockfeller's Institute. His interests in eugenics made him a controversial figure in post WW II France. All his life, he struggled to integrate his faith with his scientific curiosity, ever investigating the « power of prayer » and eventually publishing his masterpiece « Man, the Unknown» (1935). His final work « La Priere » (1944) was his spiritual testament. After a lifetime of searching, he concluded that: « Rather than a simple recitation of formulas, true prayer represents a mystical state in which consciousness is absorbed in God. This orientation is not intellectual in nature and remains inaccessible to philosophers and scientists alike. ...But in this, God ... makes himself so abundant to the man who loves, and hides [from] those who seek only to understand ».
In November 1944 Alexis Carrel died in Paris at peace with God and his Christian faith. A few years after his death, Anne, his widow, found the hidden diary of those dramatic days at Lourdes that were published posthumously, unedited, in 1949 as «Voyage à Lourdes».
Trust, Faith, and Transformation in Central Appalachia
Chelsea Jack, BA, The Hastings Center
Remote Area Medical (RAM) – a roaming free health care clinic created and managed by Stan Brock for the poor and uninsured – hosts an annual clinic each year at the Wise County Fairgrounds in Southwest Virginia. Nearly 2,000 people from Central Appalachia travel to the fairgrounds and camp out in their cars over a weekend waiting to receive dental care, preventative screenings, new eye glasses, and other health services. They wait in horse stalls, in the rain, under tarps, and in crowded trailers – and they are intensely grateful.
In July 2014, I attended the RAM clinic in Wise, VA as an interview consultant for a Duke University study on preventative screening usage among RAM patients. Virginia Governor Terry McAuliffe had traveled to Wise to meet and acknowledge the clinic patients struggling to access affordable health care in Central Appalachia. In part, McAuliffe was there to discuss Medicaid expansion; but, for many complicated reasons that this paper aims to address, his words fell on unwilling, even hostile, ears. A woman at the back of the audience shouted to interrupt him mid-speech:
“We know Jesus. And we know Stan Brock. Who are you?”
“I’m the governor,” McAuliffe replied.
Disparities in health outcomes have plagued Appalachians for far too long, and those disparities continue to feed distrust of federal health care reform. In Virginia, lawmakers reinforced distrust among their constituents this past year when the state forfeited billions in Medicaid expansion funds, excluding 400,000 poor residents who would have qualified for Medicaid coverage. Non-Appalachian residents look on with confusion and puzzle over (what is stereotyped as) the political backwardness of Appalachians who vote against the health care reforms that could serve their best interests, such as Medicaid expansion under the Affordable Care Act.
This paper investigates notions of trust and distrust in the context of health care reform in Central Appalachia. Drawing on womanist theologian Emilie Townes’ work, I examine resistance against health care reform. Though Townes focuses on African American health care in the US, I discuss how her concept of “communal lament” – a term signifying the processes of naming unjust consequences of the nation’s health care systems, seeking to repent, and then healing those injustices – might also apply to poor Appalachian residents. Their struggle to access affordable health care services in the face of socioeconomic barriers to equitable health outcomes is concretized by appeals to faith. Conversations with RAM patients helped me identify the relevance of trust and distrust, suffering, and transformation in the pursuit of an interrelated conception of how mind and body interact in Appalachian culture.
African Americans Rate "Having God's Help" as the Single Most Important Factor Affecting a Person's Ability to Quit Smoking: Results from a National Survey
Alexandra Shields, PhD, Harvard Medical School
Elyse R. Park, PhD, Harvard Medical School
Anthony Roman, MA, University of Massachusetts
Caryn Lerman, PhD, University of Pennsylvania
Anna B. Schachter, MPH, Harvard Medical School
Background: Smoking remains the leading cause of preventable morbidity and mortality, especially among minority and poor individuals. Approved cessation medications continue to be underutilized, particularly among Blacks. Emerging pharmacogenomic treatment strategies will offer improved quit rates by matching patients to the medication most likely to work for them, but fundamentally depend on smokers’ willingness to use medications to quit.
Methods: We conducted a nationally representative, random-digit-dial telephone survey of 2,400 self-identified white and Black Americans to assess lay beliefs about what most influences smokers’ ability to quit, how these beliefs differ among smokers versus nonsmokers, and across substances (nicotine, alcohol, cocaine). Measures assessing these beliefs were developed via focus groups, one-on-one interviews, cognitive testing, and pilot testing. Data was collected by the UMASS-Boston Center for Survey Research from 2008-2009. Multivariate models were fitted to assess individual characteristics associated with specific beliefs about quitting, the relationship between smokers’ beliefs and history of pharmacotherapy use, and the extent to which cultural patterns of belief persisted across substances.
Findings: We had 2059 respondents, representing a 40.1% response rate (AAPOR Method 4 formula), and 81.2% response among those we were able to reach. Fifty percent of Blacks, regardless of smoking status, believe “having God’s help” is the single greatest influence on smokers’ ability to quit (vs. 18% of whites; p<0.0001). fifty-eight percent of whites (vs. 40% blacks; p<0.0001) believe “willpower” is the greatest influence. only 3% of blacks and 7% of whites believe “medications or counseling” to be the greatest influence. these cultural patterns persisted in multivariate models controlling for self-identified race, age, sex, educational attainment, self-described religiosity, health status, and smoking status; and across substances. among smokers (n=397), those who rated ‘having god’s help’ (or: 0.20; 95% ci: 0.36-0.78; p=0.023) or ‘willpower’ (or:0.20; 95% ci:0.20; 95%ci: 0.04-0.71; p=0.015) as the greatest influence were less likely to have ever used pharmacotherapy.
Interpretation: low pharmacotherapy use among smokers will become more salient as pharmacogenomic treatment strategies, which fundamentally depend on smokers’ willingness to use medications in a quit attempt, become available. unless smokers’ lack of willingness to use medication in a quit attempt is addressed, pharmacogenomic smoking treatment will greatly exacerbate black-white and socioeconomic disparities in the burden of smoking-related illness and death. spirituality may be an important, underutilized vehicle for engaging spiritually-motivated smokers to use medications in a quit attempt.