Archive for November, 2010

The Politics of Jesus – 1

I remember hearing about this book when i was about 19. From the title I presumed that it would be a book that tells you which way to vote in elections. That being my understanding of the term politics at the time.

My interest in ethics as a field has been prompted mainly by my thinking about how modern medicine impacts our lives. Reading God, medicine and suffering has been fairly influential in this. Regular readers of the blog will likely be able to chart the drift towards this type of thing along with the copious Hauerwas references.

The Politics of Jesus has a lot to say about ethics, but perhaps not in the way that you might expect. Ethics has become a bit of a bankrupt term for me in modern medicine being largely concerned with post-enlightenment ideas on autonomy and utilitarianism that underpin a lot of medicine in general.

Three people jump to mind when I think of the ethics i’m interested – Alisdair Mcintyre (though I confess to only knowing quotes and the first few chapters of After Virtue), John Yoder and Stanley Hauerwas. They talk about a specificaly Christian ethics, primarily founded on the story of the Jesus and the people of God and the community formed since the events of the gospels.

So i’m afraid you’re gonna hear more about it.

In chapter 1, Yoder takes issue with contemporary readings of Jesus, in particular the spiritualisation of what Jesus said. Our desires to “look behind” what the gospel writers are telling us has led us to neglect perhaps some of the more obvious implications of what Jesus said

Yoder’s basic argument (that i perceive) is this – that in reading the gospels you will find Jesus of direct social relevance to social ethics, and not only relative but normative for a contemporary social ethic

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More of Hauerwas on Matthew

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Christians do not seek to be subversives; it just turns out that living according to the sermon on the mount cannot help but challenge the way things are.

Commentary on Matthew – Stanley Hauerwas

I seem to hear echoes of Vonnegut in this somewhere don’t you think? Not that I

presume they had a great deal else in common…


Quiet Revolutionaries

Reading Hauerwas’ commentary on matthew I found this on Jesus’ criticsm of the Pharisees

…yet it is crucial that Jesus criticisms of the Pharisees and scribes not overlook the challenge of the politics of the observance of the law. The righteousness of the scribes and Pharisees, their rightful desire to remain holy, was their attmept to be God’s faithful people even when they were in exile or occupied by a foreign power.

Yet too often Israel sought to be faithful in a manner that would not challenge the powers, particularly that of Rome. The Pharisees tried to observe the law without that observance being recognised as subversive to those who ruled them

I am used to understanding Jesus’ criticism of the Pharisees as their legalism and self- righteousness but Hauerwas says yes this is all true but also Jesus condemned them for not being who God called them to be – a radically different people, part of a different kingdom.

Being true followers would have put them radically at odds with empire.

A people who refuse power and violence and the social, economic and political norms are dangerous to the pervasive power structures around them

It seems Jesus condemned them for this and I find myself in the uncomfortable position of recognising myself among them.

 

Understanding salesmen

If the New England Journal of medicine turn me down I might try the Journal of Silly and Unreproducible results
Introduction
Primary prevention forms a large part of a primary care physicians work load. Numerous guidleines exist to manage high cholesterol, high blood pressure etc. Many physicians are paid by results of such targets or at least by monitoring these markers as indicators of “performance”
Risk calculators use this data to provide a risk estimate of outcomes such as heart attack or stroke over a 10 year period
These calculators typically place paients int one of three risk categories high medium or low
Little evidence exists as to whether patients have the foggiest what we mean when we tell them thy are high risk and pack them off to the pharmacy with a script for an unpronounceable pharmaceutical
Methods
We (by which I mean me) conducted a survey (n= about 10 or so…) where individuals were asked “if a doctor told you you had a high risk of MI in the next ten tears what percentage would you attribute to this?”
Inclusion criteria included bored medical students in anatomy practical, mildly intoxicated people at a fancy dress party and hosts of a dinner party and my brother’s dog lily
Exclusion criteria included those who already knew the answer and  those who could escape quickly enough to the bar before I got to them.
Results
There was 100% response rate though Lily had to be educated in the concept of numbers, self- awareness and the English language
Everyone in the study replied with a figure of between 70 and 90%
Using worst case scenarios in this calculator (selected from the top of a Google search) the highest risk was 30%
Discussion
Typical risk scores often generate a percentage of <30% for 10 year cardiovascular risk for those considered at “high-risk”. This high-risk category begins at 20%
Our (by which I mean mine) results show that there is a disconnect between what we as health care professionals mean by the term high risk
This reinforces the need to do the unthinkable and actually talk to our patients about what this actually might mean
Further research is needed in order to keep us so busy that we don’t actually find ourselves in the position of actually having to talk to the patients
Competing interests
I received no funding for this study but did find it passed an amusing half an hour on the train to Dublin on a monday morning
No individuals revived remuneration for participaing in the study though Lily received a munchie roll

The Peaceable Kingdom

Meant to post a few of these back when I was reading through it but I’m only getting round to it now.

To become followers of Jesus we must, like him, be dispossessed of all that we think gives us power over our own lives and those of others. Unless we learn to relinquish our presumption that we can ensure the significance of our lives, we are not capable of the peace of God’s kingdom.

and another favourite

The question “what ought I to do” tempts us to assume that moral situations are abstracted from the kind of people and history we have come to be. But that is simply not the case. The “situations” we confront are such only because we are first a certain kind of people.

 

Stanley Hauerwas

The Peaceable Kingdom

Fewer Moving Parts

I found these things lying in the floor of the engine compartment the other week when I was changing the fluid in the radiator (as you do…)

Bizarrely it seems they had anything to do with the Volvo failing its NCT a few weeks later.

It’ll have to go and see someone who knows what they’re doing now.

Farewell to the pressure kids

Ray Moynihan writes in the BMJ on the epidemic of pre-hypertension. At it’s simplest this is best described as a pre-disease. Your blood pressure isn’t high yet but it’s on the upper level of normal.

You don’t have to look far to see whose interest such a category might serve.

Until now the definition of what constitues a condition or pre-condition, and the guidelines for treating it, have been left largely to senior members of the medical profession and their esteemed societies, often meeting in drug-company sponsored forums like the coming Vienna conference. But for people like Professor Furberg, the profession has become too close to industry. He wonders whether it may time for society at large to take more of a role in deciding who should be classified as sick.


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