Article
Care
Comment
5 min read

The healing touch in an era of personalised medicine

As data powers a revolution in personalised medicine, surgeon David Cranston asks if we are risk of dehumanising medicine?

David Cranston is emeritus Professor of Surgery at Oxford University. As well as publishing academically, he has has also authored books on John Radcliffe, and mentoring.

A doctor looks thoughtful will holding a stethoscope to their ears.
Photo by Nappy on Unsplash.

In 1877 Arthur Conan Doyle was sitting in one of Dr Joseph Bell’s outpatient clinics in Edinburgh as a medical student, when a lady came in with a child, carrying a small coat. Dr Bell asked her how the crossing of the Firth of Forth had been on the ferry that morning. Looking sightly askance she replied;  

 “Fine thank you sir.”  

 He then went on to ask what she had done with her younger child who came with her.  

Looking more astonished she said:   

“I left him with my aunt who lives in Edinburgh.   

Bell goes on to ask if she walked through the Botanic Gardens on the way to his clinic and if she still worked in the Linoleum factory and to both these questions she answered in the affirmative.  

Turning to the students he explained  

“I could tell from her accent that she came from across the Firth of Forth and the only way across is by the ferry. You noticed that she was carrying a coat which was obviously too small for the child she had with her, which suggested she had another younger child and had left him somewhere. The only place when you see the red mud that she has on her boots is in the Botanic Gardens  and the skin rash on her hands is typical of workers in the  Linoleum factory.   

It was this study of the diagnostic methods of Dr Joseph Bell led Conan Doyle to create the character of Sherlock Holmes.  

A hundred years later and I was young doctor. In 1977 there were no CT or MRI scanners. We were taught the importance of taking a detailed history and examination. Including the social history. We would recognise the RAF tie and the silver (silk producing) caterpillar badge on the lapel of a patient jacket.  We would ask him when he joined the caterpillar club and how many times he had had to bail out of his plane when he was shot down during the war – a life saved by a silk parachute. We would notice the North Devon accent in a lady and ask when she moved to Oxford.  

The patient’s history gave 70% of the diagnosis, examination another 20% and investigation the final 10%. Patients came with symptoms and the doctor made a presumptive diagnosis – often correct - which was confirmed by the investigations. Screening for disease in patients with no symptoms was in its infancy and diseases were diagnosed by talking to the patients and eliciting a clear history and doing a meticulous examination. No longer is that the case.     

At the close of my career, as a renal cancer surgeon, most people came in with a diagnosis already made on the basis of a CT scan, and often small kidney cancers were picked up incidentally with no symptoms. The time spent talking to patients was reduced. On one hand it means more patients can be seen but on the other the personal contact and empathy can be lost.  

Patients lying in in bed have sometimes been ignored. The consultant and the team standing around the foot of the patient’s bed discussing their cases amongst themselves. Or, once off the ward, speaking of the thyroid cancer in bed three or the colon cancer in bed two. Yet patients are people too with histories behind them and woe betide the medic, or indeed the government, who forgets that.  

With computer aided diagnosis, electronic patient records and more sophisticated investigation the patient can easily become even more remote. An object rather than a person.  

We speak today of more personalised medicine with every person having tailored treatment of the basis of whole genome sequencing and knowing each individual’s make up. But we need to be sure that this does not lead to less personalised medicine by forgetting the whole person, body mind and spirit.  

Post Covid, more consultations are done online or over the telephone -often with a doctor you do not know and have never met. Technology has tended to increase the distance between the doctor and patient. The mechanisation of scientific medicine is here to stay, but the patient may well feel that the doctor is more interested in her disease than in herself as a person. History taking and examination is less important in terms of diagnosis and remote medicine means that personal contact including examination and touch are removed.  

Touching has always been an important part of healing. Sir Peter Medawar, who won the Nobel prize for medicine sums it up well. He asks:  

‘What did doctors do with those many infections whose progress was rapid and whose outcome was usually lethal?   

He replies:  

'For one thing, they practised a little magic, dancing around the bedside, making smoke, chanting incomprehensibilities and touching the patient everywhere.? This touching was the real professional secret, never acknowledged as the central essential skill.'

Touch has been rated as the oldest and most effective act of healing.   

Touch can reduce pain, anxiety, and depression, and there are occasions when one can communicate far more through touch than in words, for there are times when no words are good enough or holy enough to minister to someone’s pain.   

Yet today touching any patient without clear permission can make people ill at ease and mistrustful and risk justified accusation. It is a tightrope many have to walk very carefully. In an age of whole-person care it is imperative that the right balance be struck. There’s an ancient story that illustrates the power of that human connection in the healing process. 

When a leper approached Jesus in desperation, Jesus did not simply offer a healing word from safe distance. he stretched out his hand and touched him. He felt deeply for lepers cut off from all human contact. He touched the untouchables.   

William Osler a Canadian physician who was one of the founding fathers of the Johns Hopkins Hospital in Baltimore, and ended up as Regius Professor of Medicine in Oxford,  said:  

“It is more important to know about the patient who has the disease than the disease that has the patient”.  

For all the advantages modern medicine has to offer, it is vital to find ways to retain that personal element of medicine. Patients are people too. 

Article
Belief
Creed
Education
7 min read

The myth of secular neutrality

Where academia went wrong.

Alex Stewart is a lawyer, trustee and photographer.  

A phrenology head is shown with its eyes closed.
David Matos on Unsplash.

In the recent horror-thriller Heretic, Hugh Grant plays Mr. Reed, a sharp-witted psychopath who imprisons two missionaries, subjecting them to ceaseless diatribes about the supposed irrationality of all religions.  Mr. Reed is also a terribly smug, self-righteous bore, a caricature of the fervent atheist who dismisses faith as mere superstition while assuming atheism is objective and neutral.  

This kind of assumption lies behind the criticisms directed by secularists at those who argue from a position of faith, as we saw recently with the debates on the Assisted Dying Bill. Yet, the notion of secular objectivity is itself a fallacy. Secularism, like any worldview, is a perspective, ironically one that is deeply indebted to Christianity, and humanity’s history of abandoning faith and its moral foundation has had disastrous consequences.  

Secularism is a bias, often grounded in an ethical vanity, whose supposedly universal principles have very Christian roots. Concepts like personal autonomy stem from a tradition that views life as sacred, based on the belief that humans are uniquely created in God's image. Appeals to compassion reflect Jesus’ teachings and Christian arguments for social justice throughout history. Claims that the Assisted Dying Bill was "progressive" rely on the Judaeo-Christian understanding of time as linear rather than cyclical. Even the separation of the secular and sacred is derived from Jesus’ teaching to “render to Caesar what is Caesar’s and to God what is God’s”. Authors like Tom Holland in Dominion and Glen Scrivener in The Air We Breathe have shown how Western societies, though often disconnected from their Christian roots, still operate within frameworks shaped by centuries of Christianity.

The antidote to human pride and self-deception was to be found in the Almighty.  Ironically, it was this humility, rooted in a very theological concern about human cognitive fallibility, that gave birth to the scientific method. 

A political secularism began to emerge after the seventeenth century European religious wars but the supposed historical conflict between science and religion, in which the former triumphs over superstition and a hostile Church, is myth. Promoted in the eighteenth century by figures like John Draper and Andrew White, this ‘conflict thesis’ persists even though it has been comprehensively debunked by works such as David Hutchings and James C. Ungureanu’s Of Popes and Unicorns and Nicholas Spencer’s Magisteria. Historians now emphasize the complex, often collaborative relationship between faith and science. 

Far from opposing intellectual inquiry, faith was its foundation. Medieval Christian Europe birthed the great universities; this was not simply because the Church had power and wealth but because knowledge of God was viewed as the basis for all understanding. University mottos reflect this view: Oxford’s "Dominus illuminatio mea" (The Lord is my light), Yale’s "Lux et Veritas" (Light and Truth), and Harvard’s original "Veritas Christo et Ecclesiae" (Truth for Christ and the Church). This intertwining of faith and academia fuelled the Enlightenment, when scientists like Boyle, Newton, and Kepler approached the study of creation (what Calvin described as ‘the theatre of God’s glory”) as an affirmation of the divine order of a God who delighted in His creatures “thinking His thoughts after Him”.   

Their Christian beliefs not only provided an impetus for rigorous exploration but also instilled in them a humility about human intellect. Unlike modernity's view of the mind as a detached, all-seeing eye, they believed man’s cognitive faculties had been diminished, both morally and intellectually, by Adam’s fall, which made perfect knowledge unattainable. Blaise Pascal captures this struggle with uncertainty in his Pensées.  

“We desire truth, and find within ourselves only uncertainty....This desire is left to us, partly to punish us, partly to make us perceive from whence we have fallen.”  

For Pascal and his believing contemporaries, the antidote to human pride and self-deception was to be found in the Almighty.  Ironically, it was this humility, rooted in a very theological concern about human cognitive fallibility, that gave birth to the scientific method, the process of systematic experimentation based on empirical evidence, and which later became central to Enlightenment thinking. 

Orwell was not alone in thinking that some ideas were so foolish that only intellectuals believed them. 

Although many of its leading lights were believers, the Enlightenment era hastened a shift away from God and towards man as the centre of understanding and ethics. Philosophers like David Hume marginalized or eliminated God altogether, paving the way for His later dismissal as a phantom of human projection (Freud) or as a tool of exploitation and oppression (Marx), while Rousseau popularised the appealing idea that rather than being inherently flawed, man was naturally good, only his environment made him do bad things.  

But it took the nihilist Nietzsche, the son of a Lutheran pastor, to predict the moral vacuum created by the death of God and its profound consequences. Ethical boundaries became unstable, allowing new ideologies to justify anything in pursuit of their utopian ends. Nietzsche’s prophesies about the rise of totalitarianism and competing ideologies that were to characterise the twentieth century were chillingly accurate. Germany universities provided the intellectual justification for Nazi atrocities against the Jews while the Marxist inspired revolutions and policies of the Soviet and Chinese Communist regimes led to appalling suffering and the deaths of between 80 and 100 million people. Devoid of divine accountability, these pseudo, human-centred religions amplified human malevolence and man’s destructive impulses.      

By the early 1990s, the Soviet Union had collapsed, leading Francis Fukuyama to opine from his ivory tower that secular liberal democracy was the natural end point in humanity's socio-political evolution and that history had ‘ended’. But his optimism was short lived. The events of 9/11 and the resurgence of a potent Islamism gave the lie that everyone wanted a western style secular liberal democracy, while back in the west a repackaged version of the old Marxist oppressor narrative began to appear on campuses, its deceitful utopian Siren song that man could be the author of his own salvation bewitching the academy. This time it came in the guise of divisive identity-based ideologies overlayed with post-modern power narratives that seemed to defy reality and confirm Chesterton’s view that when man ceased to believe in God he was capable of believing in anything.  

As universities promoted ideology over evidence and conformity over intellectual freedom, George Orwell’s critique of intellectual credulity and the dark fanaticism it often fosters, epitomized in 1984 where reality itself is manipulated through dogma, seemed more relevant than ever.  Orwell was not alone in thinking that some ideas were so foolish that only intellectuals believed them. Other commentators like Thomas Sowell are equally sceptical, critiquing the tenured academics whose lives are insulated from the suffering of those who have to live under their pet ideologies, and who prefer theories and sophistry to workable solutions. Intellect, he notes, is not the same thing as wisdom. More recently, American writer David Brooks, writing in The Atlantic, questions the point of having elite educational systems that overemphasize cognitive ability at the expense of other qualities, suggesting they tend to produce a narrow-minded ruling class who are blind to their own biases and false beliefs. 

It was intellectual over-confidence that led many institutions to abandon their faith-based origins. Harvard shortened its motto from "Veritas Christo et Ecclesiae" to plain "Veritas” and introduced a tellingly symbolic change to its shield. The original shield depicted three books: two open, symbolizing the Old and New Testaments, and one closed, representing a knowledge that required divine revelation. The modern shield shows all three books open, reflecting a human centred worldview that was done with God. 

However, secular confidence seems to be waning. Since the peak of New Atheism in the mid-2000s, there has been a growing dissatisfaction with worldviews limited to reason and materialism. Artists like Nick Cave have critiqued secularism’s inability to address concepts like forgiveness and mercy, while figures like Ayaan Hirsi Ali and Russell Brand have publicly embraced Christianity. The longing for the transcendent and a world that is ‘re-enchanted’ seems to be widespread.  

Despite the Church’s struggles, the teaching and person of Christ, the One who claimed not to point towards the truth but to be the Truth, the original Veritas the puritan founders of Harvard had in mind, remains as compelling as ever.  The story of fall, forgiveness, cosmic belonging and His transforming love is the narrative that most closely maps to our deepest human longings and lived experience, whilst simultaneously offering us the hope of redemption and - with divine help – becoming better versions of ourselves, the kind of people that secularism thinks we already are.   

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