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Why Population Medicine is Anti Human – a Review of a New Book Pontifex University Professor, Michel Accad

Moving Mountains – A Socratic Challenge to the Theory and Practice of Population Medicine, by Dr Michel Accad (available from Amazon.com andd movingmountainsthebook.com

This small book is an accessible and readible account of the philosophical basis of public policy relating to medicine, which has dominated government health policy for the last 30 years at least. It arises from a branch of medicine called epidemiology, which studies the possible control of disease by statistical analysis of human behaviour and the frequency of the occurance of symptoms and disease in population groups and any population as a whole.

The writer, Dr Michel Accad is a medical doctor who regularly publishes peer-reviewed articles on the philosophical aspects of healthcare and medicine and a Catholic who is concerned especially about the de-personalization of healthcare in the US. In this book, by reference to real policies and their effects, and with analysis backed up by scientific research, he explains why, in his opinion, it has gone so wrong. He does so through the vehicle of a conversation in the style of a dialogue that one might read in Plato’s works. It is an imagined conversation between the ancient Greek philosopher Socrates and Geoffrey Rose, an Englishman who died in 1993 and who was one of the intellectual founders of population health medicine.

I would urge all doctors and anyone involved in the formulation of public health policy to read this book and consider its implications.

The starting point for our consideration is the bell curve showing the links between particular behaviour and risk of a particular in the population. In the examples given, which one assumes are typical, they appear to indicate that a certain proportion of the population is always at risk. So far so good.

The public policy that is implemented as a result of this analysis is based on an assumption that if the overal pattern of the symptoms or behaviours  of risk in the population can be controlled so that a smaller proportion of the population appear to be at risk, the rate occurance of the disease of individuals will go down too and therefore, the general health of the population will go up. So for example, blood pressure can lead to heart disease so, the argument runs, if you reduce the average blood pressure of the whole population, you reduce the rate of heart disease in the population as a whole because fewer people are at risk.

By adopting this assumption, government directs public health policy therefore to controlling, not the desease, but the shape of the bell curve – and so the signs of risk to the disease or the behaviours that is felt lead to this disease. (Public policy cannot ever control disease directly because diseases, microbes are not subject to legal penalty or taxes only human beings are.)

At first sight this seems reasonable, but in fact there are a number of problems with this method and the assumptions behind it.

Most important first: however strong the argument in advance of implementing such policy, in practice there is little evidence that it actually works in helping people. Where there have been improvements in, for example, heart disease rates, it is as easy to demonstrate that these would have occured anyway due to improvements in other treatments or better advice delivered from the doctor, with people freely choosing to adopt them rather than being influenced by government actions directly – legal or financial regulation – to behave in the desired fashion.

Second, there seem to be a number of flawed assumptions that arise from bad philosophy – a wrong understanding of society, of man and even of the scope of natural science that lead to unanticipated detrimental effects as a result of implementing such policies.

Contrary to the assumption of those who create public policy, society is not an entity that can necessarily be controlled by the laws of cause and effect of classical physics in the way that a physical process can. Attempts to do so always involve centrally planned policies that attempt to direct behaviour either through incentives (usally tax) or legal penalties and thereby direct behaviour by restricting the freedom of all individuals for the sake, supposedly, of the few within the population who might have been at risk befoe and will not be now. We can’t test this properly, because we never precisely who was at risk before and who will be saved by this policy because the figures that apply to the whole population are derived from statistical sampling of a small part of that population, not by looking at every person in the population. We are not looking at Fred or Mary and saying previously you were at risk and now you are not because we can measure how your health has improved. We are looking at a small sample of the population and looking at the statistics of that sample perhaps a thousand people and then applying the numbers to the whole population. This makes it a hypothesis that is very difficult to test even if it works and produces the desired bell curve because at best we can suggest that as a result some unkown people are at less risk. The difficulty with this is that we cannot then check for unforeseen secondary effects in the particular people who are apparently saved that might be worse than if the policy had never been implemented. We will come back to this.

In practice, though, we don’t always get the desired bell curve that public policy seeks to create. society as a whole rarely behaves as the policy intends. People cannot be controlled in this way because even if they stop doing one thing, it is almost impossible to predict what they will do instead.

Furthermore, risk of disease is rarely connected to one condition only and so the alternative behaviours that are induced by our policy might lead some people into greater risk of ill health, perhaps arising from some other unconnected disease. The mechanisms are always more complex than the picture used to describe them. This is the effect that free market economists know well – unintended consequences.

It gets worse. The recieved wisdom of what is good and bad for people changes over time and public policy, even if perfectly effective in controlling behavious, will always be behind the times as it is very slow to implement policy and change behaviour. Many will be aware that the behaviours percieved as good change as times goes on – eating butter used to be a good thing , then it was bad thing and now it is good again; saccharine was good and now is bad etc.
Nevertheless, one might argue, the science will very likely get better in time and at some point perhaps public policy could catch up and reflect it. But here’s the point: even if we understood perfectly what patterns of behaviour were best, and even if we understood how to control the pattern of behaviour and the symptom levels in population as a whole, as indicated by statistical sampling, – in other words even if the problems so far mentioned did not exist – this approach would still not help us to promote health. This is because we do not know directly how the pattern in the society as a whole relates to the effects and behaviours of any given individual in that society.
So, while we might show how a public policy might affect the public, we have very little idea how it affects each person within the public.

Accad points to this and explains how, in contrast, the promotion of personal free choice made in conjunction with advice from doctors that takes into account personal needs is still the only way we know of actually achieving greater health.

This approach to medicine doesn’t just lead to policy that tries to control the behaviour of doctors and patients. It affects too the organisation and funding structure of healthcare systems directly and, Accad argues, detrimentally. A healthcare system geared towards this end of personal freedom and the common good, in the way that Catholic social teaching describes it, would look very different from any of the systems for providing health that have existed in the US and Europe over the last 50 years.

The health insurance model (including Obamacare) in the US and the single payer systems of European countries each have this philosophical flaw built into them to detriment of both patients and doctors. So the benefits that arise from these systems are there despite the systems, not because of them. And however, much those in Europe might argue that their system is better than the America (or vice versa) each is worse than what a system could be if Catholic social teaching based upon a right anthropology were taken into account. The drawback is that the person paying is not directly involved in the provision of care ie doctor or patient, but rather is an insurance company or government department. This means that they direct policy according to trends in overall expenditure without reference to individuals and so the same problems occur. All those aspects of healthcare to which a price can be attributed are governed by this bell curve mentality. As a result the provision of healthcare becomes bureaucratic and politicised, pressures are put on doctors to change ethical practices, and even leads to the redefinition of terms such as health and disease to validate government policy to the detriment of patient and doctor.

This is not to say that we should expect no limitation on funds, clearly monetary considerations must come into play or else insurance company, or state would go bankrupt. Rather, it says that we should look for the most efficient form of distribution of a scarce commodity with alternative uses to which a price can be attached. That is the free market. Where freedom is greatest prices are cheapest and availability is greatest. Furthermore, because this encourages free choices by the main protagonists – health care providers and patients – it allows also for the greatest flourishing of those aspects to which a price cannot be attributed, for example personal care and attention and a genuinely fruitful personal relationships between those involved.

I hope very much that doctors and those who influence health policy will read this book and think about how things could be improved.
You can order it online from movingmountainsthebook.com

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Dr Michel Accad is a medical doctor with a practice in San Francisco who regularly publishes peer-reviewed articles on the philosophical aspects of healthcare and medicine. He has also has a strong interest in the philosophy of nature and philosophical anthropology and has published in The Thomist. He gives lectures around the country on these topics and on medical ethics, medical science and healthcare economics. He is a committed Catholic and faculty member of Pontifex University, for whom he is currently creating a course on the Philosophy of Nature and Philosophical Anthropology as part of the Masters in Sacred Arts program. You can contact him directly through his blog AlertandOriented.com

On ‘Strangers in a Strange Land’. A Review by Bishop James Conley

Bishop Conley, Bishop of Lincoln, Nebraska writes:

In his new book, Strangers in a Strange Land, Archbishop Charles Chaput of Philadelphia, writes that we are now living in a post-Christian world.  He suggests that we, as a culture, have not embraced atheism, but we go about our daily lives as if God doesn’t exist. We live a kind of “practical atheism,” even though large numbers of Americans would still profess a belief in God.

In the time since America’s founding, the primacy of God—God’s sovereignty—has all but disappeared from our cultural landscape.  American law and culture has distanced itself from the Gospel’s truths about abortion, contraception, immigration, poverty, technology, and education. And our views on marriage, the family, and, in fact, the very nature of the human person reflect a serious departure from the truth of God’s creation. All of us know that the impact of our cultural worldviews make our lives harder, lonelier, and more vulnerable than God wants them to be.

But the changes in our world, Archbishop Chaput claims, are not just about something happening outside of us—like the imposition of secular values from profane invaders or conquerors  Our world’s changes are also about a transformation in American hearts—a willingness, in generation after generation of American Christian believers, to choose comfort, and security, social prestige and power, even when that requires compromising the Gospel. 

To be sure, the past few decades of American life have been characterized by the imposition of a “new orthodoxy” on all Americans—a forceful expectation that all people will accept the nihilistic worldview at the heart of the sexual revolution. But even that transformation has not happened in a vacuum. And, in his new book, Archbishop Chaput says that in order to bring a renewal of joy and peace to our world, we need to understand how we got here.

In modern America, Archbishop Chaput writes that, “instead of helping the poor, we go shopping. Instead of spending meaningful time with our families and friends, we look for videos on the Internet. We cocoon ourselves in a web of narcotics, from entertainment to self-help gurus to chemicals. We wrap ourselves in cheap comforts and empty slogans, and because there are never enough of them, we constantly look for more. We enjoy getting angry about problems that we can’t solve, and we overlook the child who wants us to watch her dance, or the woman on the street corner asking for food.”

To bring renewal to our nation, Archbishop Chaput says, Catholics, and all believers, need to make a change.  We need “to be healthy cells in society. We need to work as long as we can, in whatever way we can, to nourish the good in our country and to encourage the seeds of renewal that can enliven our young people.”

To live our Christian vocation, Archbishop Chaput claims, we need to have hope.  Hope, he says, is belief “in a God who guides human affairs and loves each of us personally as a Father,” and believes that through God, we can work to make the future better than the present. Hope is not a naïve sense that everything will get better on its own, but it is the firm belief that God really cares about each one of us, and that he can redeem, and strengthen, and renew the world. Hope, Archbishop Chaput says, “is despair overcome.”

I speak with many Catholics who are tempted to despair over the state of the world. I also talk with Catholics who are tempted to give up the fight to build a just and hopeful Christian society—who would rather flee from the world, instead of believing that God can use us for extraordinary things. Strangers in a Strange Land is a testament to the fact that God cares about each one of us, and that God transforms our hearts, and can transform the world through us.

It seems as though we are living in a post-Christian world. But ultimately, Archbishop Chaput writes, “there’s really no such thing as a post-Christian world as long as the Gospel lives in our hearts and shapes our actions.” Strangers in a Strange Land is a blueprint for Christian hearts and Christian actions in contemporary American culture.

Each one of us is called to “make disciples of all nations.”  We are called to help our own nation know the Lord, honor him, and live in freedom, according to his plan. I recommend Strangers in a Strange Land to every Catholic who believes that God can heal and renew our culture, our families, and our hearts.

This article first appeared in the  Southern Nebraska Register. This is the newspaper for the Diocese of Lincoln, Nebraska. Bishop Conley has a strong interest in the connection between the practice of the Faith, with the worship of God in the sacred liturgy at its heart, and its impact on every aspect of the culture. This is further indicated by the beautiful new church at the Newman Center at the University of Nebraska and the Great Books programs that he has intiated at the Newman Institute there and which focus on the how the beauty of a Christian culture draws us to the Faith.

David Clayton writes: 

I would like to add an additional note of hope to what Bishop Conley writes.

Church of England parish church of St Mary, Studley Royal, North Yorkshire, built in the 1870s

 

In his book How to Be a Conservative the English philosopher Roger Scruton talks of the culture as the binding force for society that simultaneously reflects and reinforces the core values of that society. He argues that we should strive for a culture of beauty that reflects Christian values, the beauty of which ‘tells us that we are at home in the world’.

Sint Petrus en Pauluskerk, Ostend, Belgium

Many Americans I speak to come to look to Europe, where I come from, as a place of greater cultural beauty than America. This may be so in some ways (although I think many Americans don’t see a lot of the genuine value that is still present in American culture), but what they are thinking of are the historical remnants of a past life and culture. For the most part, the lived culture of most modern Europeans is detached from this past life even more radically than in America. One of the reasons I came to America is that it is where I think it is the place where there is greatest chance of a transforming change, that could in turn affect Europe. In this life we are never fully at home and to some degree always strangers, always pilgrims in passage to a better place; but all of us, are most at home in a culture that that reflects the beauty of God and that is a Christian culture. My personal belief is that we have all the elements that make for the transformation of the culture today into one that potentially not only equals the wonders of historical Europe but even surpasses. Those elements are man open to inspiration, God who can inspire us and his Church, the matter with which we incarnate that inspiration.

University of Richmond, VA

In a small way the gothic architectural movement that can provide some inspiration for this. It began as a deliberate reestablishment of Christian architecture in harmony with the liturgy by Catholics in England (with AW Pugin at the forefront). So beautiful and so powerful was the style he developed that within 100 years it was adopted by faithful and non-faithful alike across the globe. In fact gothic revival had an even greater impact than the original. We see its influence in buildings both grand and humble – churches, civic architecture, college architecture, homes and businesses from Moscow and across Europe, India, and the Americas. It was sheer beauty that caused this. There is no reason why we should not aim to surpass this in the 21st for the good of mankind and the glory of God in the culture as a whole, starting here in the US!

Victoria terminus, Mumbai, India By fish-bone – originally posted to Flickr as Victoria Terminus, Mumbai, CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=6922596

 

 

It’s Not Just Illuminations! Inspiring Historical Examples of the Gothic School of St Albans in Wall Paintings

Recently, I suggested that Matthew Paris and other artists of the 14th gothic illuminations (which I have called the ‘School of St Albans’ after the town where Paris lived and worked) might be a model for the reestablishement of a liturgical style for the Roman rite, in the way that the Eastern Church so successfully reestablished the iconographic tradition for the Byzantine liturgy in the middle of the 20th century. Here.

One reader wondered if it would really be possible to adapt a style that is known largely as one for illumination (ie in books and on a small scale) to full-scale liturgical art. This was a very good point. I responded that I thought that it was possible and speculated as to how I might do it. Two people have seperately reminded me of the existence of wall paintings in British churches from the 15th and 14th centuries that bear the essential characteristics of the School of Saint Albans and perhaps demonstrate to artists today some way in which a modern style that comes out of this foundation might be done on a large scale. So, thanks to Deacon Lawrence Klimecki (my fellow blogger here at Beauty of Catholicism) and Gina Switzer for this (both of whom are working artists who are taking the Pontifex University Masters in Sacred Arts).

We have seen many of these images before on this site, but it wasn’t until recently I made the connection with the stylistic connection of the illuminations of the time. It is for this reason that I represent them. The most famous church is St Cadoc’s in Glamorgan in Wales.

So just to remind you here is an illumination of shepherds being informed of the birth of Our Lord:

What characterizes this style for me is the heavy emphasis on line to describe form (rather than tonal variation); restraint in the use of color so that often the surface that is painted on eg parchment – shows through and plays a part in the image; a higher degree of naturalism in the drawing than Romanesque or other iconographic art; but like iconographic art is lives in the plane of the painting – there is little perspective and depth in the image so that it has an other-worldly and symbolic feel to it.

Now here is St Cadoc’s in Wales and then some paintings from the interior.

What strikes me about this styles also is that they will be practically slightly easier to produce as wall paintings. An artist who know what he is doing could fresco or paint on panel such paintings quickly and easily and well. This will help to bring down costs for commission and increase sales for artists who are looking to make a living.

Here are two more from different churches in England. First St Catherine in the Church of St Peter and St Paul in Pickering, Yorkshire.

And the following are at St Mary, Lakenheath, Suffolk, England.

The David Initiative

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Elizabeth Scalia at Aleteia.org reports o the David Initiative, an effort to make liturgical music as powerful as it deserves to be.

“We celebrate David for his courage as a warrior and his strength as a King, but we should never forget that before that he was a singer, a composer. The songs that David wrote were beautiful; they were passionate. They were powerful; they were moving.”

They are currently sponsoring a competition for original music with a grand prize that will appeal to musicians everywhere.

Read more:

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Pontifex University is an online university offering a Master’s Degree in Sacred Arts. For more information visit the website at www.pontifex.university

Bringing Beauty To Those Who are Starving For It – Concerts for Hope

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Eric Genuis is a world class pianist and composer with a unique ministry. He brings concerts of his classical music to prisons, to people starved for beauty.

His website has a beautiful video that says more than I can say here.

Take a look

_________________________________________________________________Pontifex University is an online university offering a Master’s Degree in Sacred Arts. For more information visit the website at www.pontifex.university

The Crown and the Artist

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Before class the other day in the good natured conversation that usually takes place as people filter in, the professor mentioned the Netflix series “The Crown.” In particular he mentioned the episode involving the portrait of Winston Churchill.

I was intrigued because I was at the time going through the episodes, I had not yet reached the episode in question.

I approached the series with some skepticism. As much as I love history I would not have thought a show about recent history, the story of Elizabeth II, would have had much appeal to me. I was very wrong. The series is beautifully produced and proves that beauty, in this case in the form of writing, acting, and production, will always attract.

***Spoiler alert for those who have not yet seen the series***

The ninth of the ten episodes deals with the painting of Churchill’s portrait and the nature and purpose of art. I was going to write an extended article about it but then I found it has already been done. Tod Worner over at the National Catholic Register beat me to the punch by about a month.

My favorite exchange from the episode is between Winston Churchill and the artist Graham Sutherland:

Churchill: … perhaps I can implore you not to feel the need to be too accurate.

Sutherland: Why? Accuracy is truth.

Churchill: No. For accuracy we have the camera. Painting is the higher art.

There’s actually a much longer, much more moving conversation involving a goldfish pond, but I will leave the reader to discover that for themselves.

Do go and read the wonderful article.

_________________________________________________________________Pontifex University is an online university offering a Master’s Degree in Sacred Arts. For more information visit the website at www.pontifex.university

10 Beautiful New Churches

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The tide is beginning to turn. After decades of church architecture that is at best liturgically questionable, more and more architects are returning to traditional forms for the newest churches.

The Christian Review has a run-up of ten that are currently in various stages of construction, Enjoy!

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Pontifex University is an online university offering a Master’s Degree in Sacred Arts. For more information visit the website at www.pontifex.university

The Third Issue of Altar Dei is Out

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We have just passed the 50th anniversary  of the release of De Musica Sacra, the document on sacred music by Pope Pius XII.

The most recent issue of Altar Dei features articles commemorating the anniversary of this wonderful instruction on sacred music from the Holy Father. The journal includes articles on sacred art, liturgy, and culture as well as sheet music.

You can purchase the third issue here: (you can also purchase issues #1 and #2)

_________________________________________________________________Pontifex University is an online university offering a Master’s Degree in Sacred Arts. For more information visit the website at www.pontifex.university

 

Pope Francis on Sacred Music

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Aleteia.org has the English translation of Pope Francis’ recent address to participants in a conference on sacred music.

“At times, a certain mediocrity, superficiality and banality have prevailed to the detriment of the beauty and intensity of the liturgical celebrations. That is why the various actors in this field, musicians and composers, conductors and singers in scholae cantorum, and those involved in the liturgy, can make a valuable contribution to the renewal —especially in quality of sacred music …”

Read more here:

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Pontifex University is an online university offering a Master’s Degree in Sacred Arts. For more information visit the website at www.pontifex.university

 

The Catholic Artists Society Archives

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“The Art of the Beautiful” is a lecture series sponsored by The Catholic Artists Society in New York City. The series is designed to explore how the Catholic faith informs the arts.

For those if us who do not live in the area and cannot attend the lectures, the society has made the most recent lectures available in their archives. These include:

“The Sacred Liturgy as a Primary Source for Artist’s Imagination” by Jenifer Donelson

“Art and Transformation” by James Patrick Reid

“Image and Likeness” by Anthony Visco

Take a look here.

While you’re there be sure to browse through their archives where they have material dating back to 2011.

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Pontifex University is an online university offering a Master’s Degree in Sacred Arts. For more information visit the website at www.pontifex.university