Notebook: medicine, culture, religion, death

Modern medicine, particularly in the United States, has redefined success in treatment. There was a time when the highest objectives of medicine as an art were the relieving of suffering and the comforting of the patient as he faced his demise. Medicine's origins in the ethno-religious realm meant that many treatments were not intended necessarily to change the course of the disease so much as to relieve the effects on the soul (fear, anguish, sorrow).

The effect that came to be known in modern medicine as the placebo effect undoubtedly evolved along with the rise of culture, which religion and medicine needed in order to evolve. A dance or a song or a salve or an elixir took its power from the shaman who administered it, who in turn took his authority (and power) from the cultural milieu in which he achieved elevation to his place in the tribe, band, or in time, the community, village, city, or country.

I often wonder, how did we get to this point where the urgency in the HIV/AIDS epidemic has made men want to slice flesh from the bodies' of others. That's a pretty dramatic way of putting it: to slice flesh. But this is the way it would have been understood in earlier pre-modern cultures. Circumcision, male or female, has not historically been understood as a simple and easy procedure without any undue effects other than a little initial pain. Pain often was an integral part of the experience. Rather it was understood as a sacrifice to be faced bravely, which in turn gave status to the individual who survived it. And make no mistake about it, in past times, circumcision was survived, not merely endured.

Modern medicine defines success as the avoidance of death. If the patient lives, the doctors congratulate themselves. The sacrifice needed to survive beyond the illness is often unacknowledged or its mention perceived as complaining in the face of success.

Informed consent is often not taken seriously in situations where death is a likely outcome, often regardless of how remote. Nevertheless, it is recognized that adults can't simply be ordered to be circumcised. Some level of physical integrity must be respected. Therefore, it is hardly surprising that Halperin and Bailey and others have revealed their true intentions are to impose infant circumcision in Africa and encourage its reimposition in America.

Whatever drives these men to praise circumcision, despite recent research that says multiple, concurrent partners, lack of proper hygiene, lack of knowledge and education, and a shortage of condoms are the true drivers of this epidemic, lurks in the darkness of their psyches. Only in a milieu that defines medical success as the avoidance of death, could such a sacrifice be demanded without recognition or acknowledgment of its true origins and known limitations, and the possibility that some people would resist the sacrifice and believe themselves reasonable to do so.

Quality of life is a relatively recent concern in medicine that does not have its origins in the modern medical establishment. In fact, doctors who go against the grain to emphasize quality of life are often ostracized and even driven out of the profession. I am thinking primarily of the prosecutions and complaints against doctors that prescribe pain medications or support self-administered euthanasia instead of futile treatments. Other examples surely exist.

I am surprised because I expect reason and logic when, as in all things human, personal beliefs and bias are more reasonable to expect. In point of fact, no one should be surprised that male circumcision (among other mostly useless treatments: formerly beat juice and exercise in South Africa) is being proposed where death can't be evaded. In this, it is offered not as a prevention, but as a shamanic ritual for the doctors and patients alike.