nucleus - Christian Medical Fellowship

nucleus - Christian Medical Fellowship

nucleusthe student journal of the christian medical fellowship christmas 2008homelessnessprayer for healing climate change doctors' rights

Richard Dawkins argues that the Christian Godis petty. Why else would he ‘torture himself’on a cross for human sin (pp4-6)? Dawkins iswrong, because he does not understand theseverity of sin – an appalling rejection ofGod’s rightful rule as the creator, sustainer,and giver of all life.In stark contrast, the psalmist sings gratefully ofGod’s generosity: ‘When we were overwhelmed bysins, you forgave our transgressions. Blessed arethose you choose and bring near to live in yourcourts! We are filled with the good things ofyour house, of your holy temple.’ (Ps 65:3,4)At the same time, Dawkins is partly right inaccusing the Christian God of being petty. OurLord is petty enough to care about ‘trivial’ and‘unimportant’ people in society:For he will deliver the needy who cry out, theafflicted who have no one to help. He will take pityon the weak and the needy and save the needyfrom death. He will rescue them from oppressionand violence, for precious is their blood in his sight.(Ps 72:12-14)I am struck by how the psalmist’s words stillring true today. While I take comfort in God’sunchanging faithfulness and compassion, I realisethat there are still many amongst us who areneedy, afflicted and weak. And they still needrescuing from oppression. For homeless peopleand asylum seekers, ‘access to proper primaryhealth care is jeopardised by the negativereaction of care providers’, even though theirright is enshrined in law, writes Peter Campion(pp15-19). I pray that we will have the courage andconviction to serve vulnerable groups rightlywhen we become doctors, responding to a truevision of God’s justice and mercy.Even as medical students, we can take stepsto understand the needy. Awareness producescompassion, leading to service. In Cardiff, threeChristian medical students designed their ownspecial study module to investigate healthcareprovision for the homeless (pp20,21). AndyMeeson goes out with a medical van to tend toManchester’s homeless each week (pp22,23).I was personally encouraged and challengedby their testimonies. In both cases, they weremotivated by the love of Jesus; they dependedon God’s strength; and they sought to glorifyGod in their actions. This is what the Lordrequires of us all – whatever we are called todo, and whoever we are called to serve.Hugh Ipnucleus christmas ‘ 0803

has science buried God?Camilla Day reportson the exciting debatebetween Dawkinsand LennoxIqueued up outsideOxford’s Natural HistoryMuseum clutching acoveted ticket to the sold-outevent on 21 October. It was onlythe second time for RichardDawkins and John Lennox todebate the existence of God,and the first on English soil.Richard Dawkins is the wellknownauthor of The GodDelusion, 1 recently retired asProfessor of the PublicUnderstanding of Science atOxford University, and sponsorof the atheist bus campaign. 2His opponent, John Lennox, isProfessor in Mathematics at theUniversity of Oxford and Fellowin Mathematics and Philosophyof Science at Green College,Oxford. He is a Christian whowrote God’s Undertaker: hasscience buried God? 3 inresponse to The God Delusion.questions in my mindWas I going to be persuaded by‘the Dawkinator’? Had I beeninfected with a ‘religious mindvirus’ for the past four years ofmylife?Perhaps I wasreally nothingmore than acomplexproduct of thesingularityfrom which theBig Bang originated. 4Although I had heard in highbrowcircles, Christian andsecular, that Dawkins was toopolemical to be taken seriously,I felt that his proposition of the‘selfish gene’ was a real threatto my faith. But all too soon Ifound myself at the entrance tothe museum and it was too lateto turn back.Dawkins began by asking howLennox could claim to be ascientist and yet believe watercan be turned into wine. 5 Afterputting Jesus in the spotlight,he did not grant his opponentthe same courtesy. WheneverLennox spoke about Jesus,Dawkins accused him of fancifuldigression from science and hewas reluctant to engage. Lennoxtook that in his stride,expressingconcern over Dawkins’ denialof Jesus’ existence, not tomention his death andresurrection. Cornered, Dawkinswas forced to concede thatmost historians did think heexisted. But he attempted todismiss the point by sayingthat the whole story ofJesus was petty.04 nucleus christmas ‘ 08

jaw-dropping momentDawkins was adamant that hedid not believe in the pettyChristian God who cares aboutsin and ‘tortured himself’ on thecross. Lennox’s rebuttal wasthat sin and consequentalienation from God are in factthe most important questions inlife. Nevertheless, Dawkinsadmitted that ‘a serious casecould be made for a deisticgod’. This concessionalmost went by unnoticed,but journalist MelaniePhillips explains itsgravity: 6Here was the arch-apostleof atheism, whose wholecase is based on the assertionthat believing in a creator of theuniverse is no different frombelieving in fairies at the bottomof the garden, saying that aserious case can be made for theidea that the universe wasbrought into being by some kindof purposeful force…True, hewas not saying he was now adeist; on the contrary, he stilldidn’t believe in such apurposeful foundingintelligence…Nevertheless, toacknowledge that ‘a serious casecould be made for a deistic god’is to undermine his previouscategorical assertion that:‘...all life, all intelligence, allcreativity and all “design”anywhere in the universe isthe direct or indirect productof Darwinian naturalselection...Design cannotprecede evolution and thereforecannot underlie the universe.’ 7While Dawkins couldcontemplate a god, he said thatthis was incompatible with ‘agod who cares about our sins’,‘what we do with our genitals’,and what we think about. Thisimplies that his objection to theChristian God is not scientificbut theological.evolution and designLennox argued that evidence ofdesign in the universe impliedthat there must be a creativemind behind it. Dawkinscountered by saying that it ismindless Darwinian evolution,the ‘blind watchmaker’, givingthe impression that life wasdesigned. Lennox said that hebelieved in evolution as amechanism but that it wasa separate assumption thatthere is no agent behind themechanism. He cited theexample of his watch; it ‘is blindand automatic but that doesnot mean it wasn’t designed, farfrom it’. Dawkins argued that ifa stone fell to the ground, onehas science buried God?would acknowledge that it fellby gravity, not because Godcaused it to fall in the sameway time and again. An agent issuperfluous to the explanationof life. But Dawkins admittedthat he had no explanation forthe origin of life; he believesthat a naturalistic explanationwill one day be discoveredby a ‘Darwin of the cosmos’.However, Dawkins said somesurprising things to MelaniePhillips after the debate:…rather than believing in God,he was more receptive to thetheory that life on earth hadindeed been created by agoverning intelligence – but onewhich had resided on anotherplanet. Leave aside the questionof where that extra-terrestrialintelligence had itself comefrom, is it not remarkable thatthe arch-apostle of reason findsthe concept of God more unlikelyas an explanation of the universethan the existence andplenipotentiary power of extraterrestriallittle green men? 8Darwin, himself an agnostic,wrote, ‘it seems to me absurdto doubt that a man may bean ardent theist and anevolutionist’. 9 Lennox said thatthe stunning Natural HistoryMuseum they were sitting inhad been built by such Victoriannucleus christmas ‘ 0805

has science buried God?theists for the glory of theirGod. Dawkins rejected thisproposition, but he was wrong.The Regius Professor ofMedicine at the time ofconstruction, Sir Henry Acland,explained that the building wasfor obtaining the ‘knowledge ofthe great material design ofwhich the Supreme Master-Worker has made us aconstituent part’. In fact, thefunds for the building camefrom the surplus in theUniversity Press’ Bible account!hear them for yourself!Unlike the rigid format of theirfirst debate (see box), this eventwas a more fluid conversationbetween the two. In addition tothe topics I highlighted above,they expounded on subjects fromtheir books along the lines ofrationality, morality, and justice.Both speakers were remarkablecommunicators. Lennoxcertainly held his own, evenwhile Dawkins was articulateand logical. But even so,Dawkins disengaged with theconversation at certain pointsand disappointingly resorted toemotive dismissals of God as‘petty’, an ‘imaginary friend’ ofthose who need to grow up, andfaith as ‘fantasy’. Consequently,I not only felt substantially lessDawkins versus Lennox, round one– The God Delusion DebateOctober 2007, University of Alabama (USA)The two Oxford professors first debated each othera year ago. The free online video 11 is an easy way in tounderstanding the key arguments in Dawkins’ book and theChristian riposte. It is also an excellent opportunity to spark offdebate with non-Christian friends on the topic. I thought thatLennox finished the debate ahead on points but with noknockout blows.The structure is a little strange, hampering the flow of thearguments. Dawkins expands on six theses, from The God Delusion,one after the other. These include: ‘science supports atheism notreligion’ and ‘religion is dangerous’. Lennox then responds to eachargument. The format puts Lennox at an advantage as he canalways critique Dawkins’ arguments, whilst Dawkins does not havethe opportunity to reply. Having said that, both speakers areengaging and often amusing as they stake their ground– it is well worth watching!Will Taylor is a CMF student internthreatened by his ideas; I wasdisappointed by his ignoranceof the historicity of JesusChrist. Science certainly has notburied God! But you do not needto take my word for it; make upyour own mind. The audiorecording of the debate isavailable for sale online. 10 It iswell worth your time; you don’teven need to stand in line!Camilla Day is a final yearstudent at Warwick MedicalSchoolREFERENCES1. Dawkins R. The God Delusion.London: Bantam, 20062. Lennox J. God’s Undertaker.Oxford: Lion, 20074. Paul J. The God delusion and thehuman illusion. Nucleus2007;Autumn:22-95. Jn 2:1-116. www.fixed-point.org11. www.dawkinslennoxdebate.com06 nucleus christmas ‘ 08

John Patrick’s UK TourWill Taylor reflects on a thought-provoking lecture seriesthe manJohn Patrick is a well known speaker in NorthAmerica where he has lived in Canada for muchof his life after training as a doctor in the UK.He was a main speaker at the CMF studentconference in 2003 and is a frequent speakerat international ICMDA conferences, so we jumpedat the chance of having him tour around theUK from 13-17 October, all the way from frozenAberdeen in the north to sunny Brightonin the south.the tourHaving helped in the organisation of the tour butnever heard him speak I wasn’t quite sure whatto expect. But he spoke very well across all thevenues. In total around four hundred peopleheard John speak in nine talks at eight differentuniversities on subjects like ‘Much more thana baby dies in abortion’ and ‘Can we be goodwithout God?’ I heard him speak on ‘WhatHippocrates knew and we have forgotten’at University College, London.the talkJohn started by stating that everyone wantsa doctor they can trust. He went on to point outthat your tutors and deans don’t know whichof your year group are trustworthy - they onlyknow the people who pass exams; but you willknow within weeks the people who you wouldnot want near your granny.Trust is a vital part of Hippocrates’ oath. Inancient Greece the doctor and the assassin wereone man; so you could not trust your doctorbecause someone else may have paid them moreto kill you. What Hippocrates and his oath did wasguarantee that the doctor would try his utmost tocure you, and never kill – including abortion andeuthanasia. Patients voted with their feet and theonly doctors that survived in the western worldwere those who followed the oath. This has beenlost as abortion is commonplace and euthanasiamay become so; doctors can easily becometechnicians of a service rather than holistichealers.The other vital aspects of the oath are:transcendence (acknowledging a higher authoritythan humanity), the sanctity of life and the moralintegrity of the physician. John outlined why thecurrent trend to ‘update’ the Hippocratic Oathactually removes some of its core values.more informationJohn has previously expanded on the HippocraticOath in Nucleus and you can read it online. 1 Hiswebsite is well worth a look, with several of hispapers and talks, including the ones he gave onthis tour - We also hope tohave him back in the UK before long, so watchthis space!Will Taylor is a CMF student internREFERENCES1. Patrick J. Hippocratic Medicine; preserving ancientvalues. Nucleus 2003; October:14-21nucleus christmas ‘ 0807

meet Vicky LavyVicky Lavy wants to helpus look beyond our bordersyou’ve just started working forCMF as Head of InternationalMinistries. What is the jobabout?It’s all about raising the profile of global healthissues in CMF and getting people interested inwhat’s going on beyond our world of the NHS andthe UK, particularly in the developing world wherethe health needs are so great. It’s also aboutbeing a resource for those who are alreadyworking overseas, or are planning to go –providing information, advice, contacts andliterature.Another part of my job is developing partnershipsbetween CMF and the many other nationalChristian medical associations around the worldthat are part of the International ChristianMedical and Dental Association (ICMDA).why should today’s students beinterested in medical workoverseas?I think every single Christian should be concernedabout the poor because that’s what God has toldus. Did you know there are more than 2,000verses in the Bible about poverty and injustice?For instance, Proverbs 21:13 tells us, ‘If a manshuts his ears to the cry of the poor, he toowill cry out and not be answered.’ Then thereis a surprising reference to the wicked cityof Sodom in Ezekiel 16:49:Now this was the sin of your sister Sodom: Sheand her daughters were arrogant, overfed andunconcerned; they did not help the poor and needy.Christian doctors – and students – are in a primeposition to serve those who are neglected byothers. Of course we can do that in this country,but we simply can’t pretend that the medicalneeds here are as pressing as those in thedeveloping world. Europe and the USA have 20%of the world’s disease but 72% of the world’shealth workers and 85% of the world’s healthbudget. It’s a terrible injustice – but as medics, weare in a position to do something to put it right.what did you do before youstarted at CMF?My background is in general practice but I spentten years in Malawi where I did a variety of jobs– including running around after our three boys.I spent the last four years of our time there08 nucleus christmas ‘ 08

meet Vicky Lavysetting up a palliative care service for children,which was one of the most fulfilling things I’veever done. Since we came back to England I havebeen doing paediatric palliative care at HelenHouse Hospice in Oxford, but I’ve given thatup now to come and work for CMF.I was also involved in getting a CMF going inMalawi, which was great fun and also veryrewarding – it started with a small bunch ofstudents in 1997, and now it’s a nationalfellowship. It’s been wonderful to be involved withmedical students and watch them as they grow,progress, and qualify, then to see them inleadership positions in Malawi.tell us about your familyMy husband, Chris, is an orthopaedic surgeon.He works part time for the NHS and part time onvarious projects promoting orthopaedics in thedeveloping world – such as research, training andalso setting up hospitals where disabled childrencan have surgery to get them walking.We have three boys who are 13, ten and eight.Some Nucleus readers may even remember themfrom the students’ conference this year as theywere conspicuously younger than everyone elsethere! They were the ones playing football andamassing vast piles of glow sticks.what would you recommend asa first step for a student lookingto get involved in internationalwork?Electives are a prime opportunity to get a tasteof working abroad. There’s lots of informationon CMF’s Healthserve website about planningelectives and lots of useful addresses – think everyone should at least consider goingto a developing country, even if they have nointention of working overseas after qualifying.The way we live in the UK is the exception ratherthan the rule – two thirds of the world’spopulation live in the developing world and havea fraction of the resources that we enjoy. It’simportant that we know what life is like for ourbrothers and sisters in the rest of the you plan to be involved withstudents in your new role atCMF?Yes, definitely. I’ll be at Swanwick in February forthe national students’ conference (along with myboys – they’re looking forward to it already) andhope to meet lots of students. Then we’ll behaving an electives day in London (probably inMarch) where we’ll have several experiencedpeople talking about the issues of working in adifferent culture, and how to go about planningand getting ready. If other student groups wantto hold an event like this, we can send a varietyof resources from CMF and provide a speaker– if I can’t come myself, I’ll find someone goodwho can.And don’t forget, I’m there to answer anyquestions, big or small, about international issuesand options for working overseas. You can emailme on – I’d love to hearfrom you!Vicky Lavy is CMF Head of InternationalMinistriesnucleus christmas ‘ 0809

the Yorkshire three peaks challengeCat Handforth fundraised through wind, rain, and bogThe Yorkshire three peakswalk is a substantialphysical challenge.The circular route incorporatesPen y Ghent (691m), Whernside(728m) and Ingleborough(723m). The 26 mile walk, with atotal ascent of over 5,000 feet,must be completed withintwelve hours.The National Students’Committee (NSC), in theirwisdom, decided that this wouldbe the perfect group challenge!On 8 August, we descended ona village deep in the YorkshireDales with three aims: conquerthe peaks, have fun, and raisemoney. The funds would gotowards subsidising our annualnational students‘ God’s safe handsThe original accommodationplans fell through days beforethe event, so Foxwood Farm wasa huge answer to prayer. Itsspacious lounge, drying room,hot showers and comfortablebeds met all our needs.The 15 walkers, divided intothree teams, included studentsand CMF office staff fromOxford, Manchester, Warwick,London, Hull and Leeds. Wefound out it was not a holidaywhen we were rudely awokenat 5am. Revived by a heartybreakfast and lots of caffeine,we were given rather simpleinstructions: not to lose oneanother or get lost by ourselves!From 6am the teams set off atintervals. It was such a relief, formany of us city dwellers, to be inthe middle of nowhere, enjoyingfresh air and birds in full song.We were not surprised to seeother ‘three-peakers’ setting outfor the day; one man with acigarette and beer can in hand.We wondered how his lungfunction and neurological controlheld out through the day!climbing the peaksThe first peak (Pen y Ghent) wasonly a few miles from the start,but we had to endure the steepand blustery ascent to thesummit. Once there, we wererewarded by stunningpanoramic views; we could evensee the twelve miles we neededto walk to reach the next peak.Unfortunately, the sky becamedark and cloudy by 9am, whilea fine drizzle swirled aroundus. The rain got steadily heavier,as we headed up the valleytowards the second peak,turning the ground into anenergy-sapping bog. A few10 nucleus christmas ‘ 08

the Yorkshire three peaks challengeif we can raise£5,000…of us got stuck and needed helpgetting out!By late morning we reachedRibblehead. The second peakloomed large above the viaductwhere CMF marshals werestationed. We refuelled in theshelter of their car boots andumbrellas; we also appliedplasters to blistered feet andjoked about the rain not stopping.Whernside had a series of bigsteps on a ridge; made moredifficult by soaking wet clothes,waterlogged boots and icy coldlegs! Even staying on the ridgewas a battle, as we were at themercy of howling wind andpelting rain. We came down theother side with trepidation:slippery rocks, weary legs andimpatience do not make a safecombination!I thanked God for the café inthe middle of nowhere, wherewe took a welcome break.The shelter, tea and chocolatepsyched us up to conquer thefinal peak. Ingleborough wasthe steepest of the three andwe found it tough work!After getting up and downthat peak, one final challengeremained – a ford separatedus from our front door. Whatstarted the day as a gentletrickle had become a small lake!Somehow we crossed over, andall 15 walkers were back safelyby 6pm. Our barbeque planswere thwarted by the elements,but we were just glad to bewarm and dry inside!Our small group managed toraise over £5,000. It is excitingto think how much we couldraise with more people!Charlotte Hattersley (CMFNorthern Student TeamLeader) capablymasterminded this operation.The team was also blessed witha fantastic array of useful skills,including: porridge making,umbrella holding, taxidriving, human signposting,encouraging and the inevitablefirst aiding!This weekend proved thatfundraising together can belots of fun. The NSC encourageslocal CMF groups to organisecreative events at your ownmedical school. From cake salesto organising revision sessions,and even sky dives – thepossibilities are endless and thecause is worthy! Have a look for more ideas.Cat Handforth is a clinicalstudent at the University ofLeeds and an NSC repnucleus christmas ‘ 0811

news review 1Human Fertilisation andEmbryology BillThe 1967 Abortion Act has led to 6.8 millionabortions. The 1990 Human Fertilisation andEmbryology Act provided for various forms ofassisted conception, but through allowing embryofreezing, research and disposal up to 14 days hasalso destroyed 2.2 million human embryos – atotal of nine million early human lives in 40 years.The 2008 Human Fertilisation and Embryology Billgoes further by bringing in more liberal embryoresearch, saviour siblings, animal-human hybrids,fatherless IVF children, and by making legalwithout explicit consent the use of tissue fromchildren, mentally incapacitated adults andpeople who have died, in order to make clonedand hybrid embryos.All attempts to remove these provisions from thebill, or to legalise them only when alternativeresearch routes did not exist, were defeated in bothLords and Commons as government Peers and MPsfaced a three line whip. Most would have voted thisway regardless, due to a successful propagandacampaign by the Times, backed by various scientificinstitutions, patient interest groups and MPs.The Prime Minister was key when he wrote inMay to support embryonic stem cell therapy andanimal-human hybrid research, despite scientistsworldwide turning to the ethical alternatives ofadult and cord blood stem cells and inducedpluripotent stem cells.The bill completed its eleven month journeythrough Parliament on 29 October with a debatein the Lords and now needs only royal assent, amere formality, to make it law. The only savinggrace has been that the abortion law has notbeen further liberalised. It was a huge answer toprayer when liberalising amendments calling forabortion on request up to 24 weeks, nurse and GPsurgery abortion, and extension to NorthernIreland fell. At the eleventh hour the governmentacted to prevent debate on these. The new HFEAct is certainly bad, but could have been evenworse. ( 2008; November, 2008; 18 May, 2008;22 October)one stop embryo testCurrent tests for inherited diseases are specific;they can only identify a few hundred conditions.A ‘one stop’ gene mapping test may be availablesoon. It will tell parents if embryos are affectedby almost any of 15,000 inherited diseases.The test involves removing one cell from an eightday-oldembryo, created by IVF. The family’sgenetic map is produced using DNA samples fromthe parents, grandparents and often a relativeaffected by a specific condition. If a block of DNAhas been passed on by the paternal grandfatherto the affected relative, the test can determinewhether this block is also present in the embryo.The test is currently being trialled. If a licenceis granted from the Human Fertilisation andEmbryology Authority, this would set a worryingnew horizon for pre-implantation geneticdiagnosis. Furthermore, the test could potentiallygenerate genetic profiles, indicating susceptibilityto conditions such as heart disease and cancer.‘But obviously, the ethical question is, if you canscreen for anything, where do you draw the line?’says Dr Mark Hamilton, chairman of the BritishFertility Society. ( 2008; 24 October)12 nucleus christmas ‘ 08

news review 2genetically uncommitted?A gene variation may contribute to commitmentproblems in men, according to a study from theKarolinska Institute in Sweden. Interest in the roleof vasopressin (ADH) in human sexual behaviourarose after the discovery that variations in ADHreceptor expression make prairie volesmonogamous but meadow voles promiscuous.The recent study looked at the gene coding foran ADH receptor, in 552 Swedes in heterosexualrelationships lasting at least five years. Variationof the RS3 334 section of the gene was related tohow well men bonded with their partners. Thosewith two copies (rather than one or none) weremore likely to be unmarried than the others, andif married, they were twice as likely to have amarital crisis.It is not yet clear how this polymorphism affectsADH receptor expression and consequently ourintimate relationships. But unlike voles, humancapacity for moral behaviour enables us toexercise choice no matter what our biologicalpredispositions. (New Scientist 2008; 1 September,Proc Natl Acad Sci USA 2008;105:14153-6, EmoryReport 1999; 7 September)physician assisted suicideDebbie Purdy, wheelchair-bound with primaryprogressive multiple sclerosis, may want to dieat Dignitas (the Swiss assisted suicide facility) atsome point. She believes the law is unclear andworries that her husband will be prosecuted if heaccompanies her (around 100 Britons are thoughtto have committed PAS at Dignitas, and so far,none of their relatives have been prosecutedfor assisting a suicide).In October, High Court judges sat for a judicialreview and decided that the law is enough. MrsPurdy, a member of Dignity in Dying (formerly theVoluntary Euthanasia Society), which campaignsfor the legalisation of PAS and euthanasia in theUK, is said to be appealing the decision.Now though, the Crown Prosecution Service isconsidering whether to prosecute the parents ofDaniel James, a 23 year old paralysed last yearwhen a rugby scrum collapsed. His parents tookhim to Dignitas in September this year, where hedied. Unlike most British patients choosing to diein Switzerland, Daniel was young and hiscondition, though distressing, was neitherprogressive nor terminal.( credit crisis and healthThe UK government’s multi-billion pound bailoutwill inevitably leave the nation in debt. But theNHS should face little danger in the immediatefuture. NHS spending is guaranteed up to April2011, but the long term effects will depend onthe length of the credit crisis and the aftermath.Tax raises and funding cut-backs, in an attempt torecoup borrowed money, may lead to a reducedworkforce and increased poverty. Health servicesavailable to patients may decrease. Private sectorsuppliers may be affected and private financeinitiative schemes may undergo re-evaluation.The global impact of the credit crisis is predictedto leave 44 million more people malnourished in2008 as a result of increased food and fuel prices.The Millennium Development Goals seem evenless likely to be fulfilled by the target of 2015.(BMJ 2008;337:2259, Lancet 2008;372:1520)nucleus christmas ‘ 0813

news review 3placebo prescriptions are rifeOver half of US GPs and rheumatologists admittedprescribing ‘placebo treatments’ to some of theirpatients, in a recent survey. More than 62%believed this was ethical. They rarely called thesetreatments ‘placebos’, instead referring to themas ‘a potentially beneficial medicine or treatmentnot typically used for their condition’. However,a 2006 American Medical Association statementreads, ‘Physicians may use placebo for diagnosisor treatment only if the patient is informedof and agrees to its use’.Most placebos were innocuous vitamins andover the counter analgesics, but antibiotics andsedatives were also prescribed by 13% of doctorssurveyed. The use of placebo treatments remainsa controversial topic for ethical and policydebates. While it may be physically beneficialfor patients, this practice is paternalistic andjeopardises patient trust. (medicalnewstoday.com2008; 25 October)religion, pain and depressionTwo recent studies explore the link betweenreligion and health. The first, from OxfordUniversity, addressed pain perception. WhenCatholics and ‘non-believers’ were subjected toelectric shocks, Catholics experienced 12% lesspain than the group of atheists and agnosticswhen viewing an image of the Virgin Mary. Brainscans showed that the ventrolateral prefrontalcortex was more active in Catholics. Theyengaged a ‘brain mechanism that is well knownfrom research into the placebo effect, analgesiaand emotional disengagement’, said the leadresearcher. It ‘helps people to reinterpret pain,and make it less threatening.’An American study looked at religiosity and therisk of depression. Individuals with a higher levelof religious well-being were 1.5 times more likely tohave had depression than those with lower levelsof religious well-being. The authors, surprised bythe findings, suggested that this could be due topeople with depression using religion as a copingmechanism. Consequently, depression is linked topraying more. ( 2008; 1 October,medicalnewstoday 2008; 24 October)evolution is complete?Human evolution remains a controversial theory.But for those who believe it, it may be coming toan end in humans for three reasons, according toSteve Jones, Professor of Genetics at UniversityCollege London. ‘In ancient times half our childrenwould have died by the age of 20. Now, in theWestern world, 98% of them are surviving to theage of 21...Natural selection no longer has deathas a handy tool.’Secondly, there is less potential for randomalterations to our genetic blueprint. ‘…The meanage of male reproduction means that mostconceive no children after the age of 35,’ saidProfessor Jones. ‘Fewer older fathers meansthat if anything, mutation is going down.’Thirdly, ‘Small populations which are isolatedcan…evolve at random as genes are accidentallylost. Worldwide, all populations are becomingconnected and the opportunity for randomchange is dwindling.’ ( 2008;7 October, 2008; 7 October)Jenny Chui, Sarah MacLean,Rachael Pickering, Peter Saunders,Sheldon Zhang14 nucleus christmas ‘ 08

homelessness and asylumPeter Campion asks us toconsider our own prejudicesa trampasking to be‘There’sseen today’,said the receptionist tothe practice manager. Shewas not sure whether sheshould register this man, and ifso, how. Was he ‘immediate andnecessary’, or a ‘temporaryresident’? What should she putfor his address? He said he wassleeping in the park.The last time she let a ‘tramp’into the surgery, patientscomplained to the managerabout the smell in the waitingroom, the doctor complained tothe receptionist because he didnot like alcoholics, and thepractice nursegrumbled because shespent half an hour dressing hisleg ulcers! The last straw waswhen he managed to leavewithout completing thepaperwork. The manager saidto fit him in if there was a freeslot, and otherwise suggestedhe went to the hospital.As there were no spareappointments, the receptionisttold him to go to accident andemergency (A&E), about amile away. He limped away,looking sad.A dark-skinned womanapproached the window, saying,in broken English, ‘I must seedoctor’. The receptionist feltmore confident here, becausethere was a policy. But shealways found these peopledifficult, and she knew thedoctors did not like themregistering, because they tookup so much time. She told thewoman that she had to phonein the morning, to allow time toorganise an interpreter. Thewoman did not understand, butnucleus christmas ‘ 0815

homelessness and asylumsensing a rejection, spoke moreforcefully, ‘I must see doctornow!’ The receptionist,conscious of the practice’szero tolerance policy towardsaggression, thrust a multilingualleaflet into the woman’shands and closed the window.The woman could not read, andturned away in tears.Do these scenarios resonate foryou? Maybe your last encounterwith a homeless person wasduring your A&E attachment, orin general practice. What about‘immigrants’ who have limitedor no English? Street homelesspeople and asylum seekers areamong the more visible of the‘marginalised’ or ‘sociallyexcluded’ groups. But there aremany others whose access toproper primary health care isjeopardised by the negativereaction of care providers.laws and loopholesUnder UK law, both the RaceRelations Act 1976 (amendedin 2000) and the DisabilityDiscrimination Act 1995(amended in 2006) govern howwe provide healthcare. Whilethe less well known but highlyrelevant ‘right to health’ (foundin article 12 of the InternationalCovenant on Economic, Socialand Cultural Rights, ratified bythe UK Government in 1968) 1adds a moral, if not a legal,dimension.Under the NHS, healthcareshould be available to all UKcitizens at the point of need,regardless of the nature of thehealth problem, race, religion,occupation, sexual orientation,or any other label. That term‘citizen’ highlights one of theissues – there are rulesdetermining entitlement to NHScare for non-citizens, whetherEuropean Community (EC)citizens, non-EC visitors, asylumseekers, or so-called ‘failed’asylum seekers. 2But neither a street homelessperson who is a UK citizen, noran asylum seeker whose case isunder consideration by the UKBorder Agency (UKBA), fall intothe category of those who arenot entitled to NHS care. 2 Sowhy do these scenarios seemso familiar?problems andprejudicesConsider the reasons why thishypothetical practice raisedbarriers to our homeless man: He had no fixed address He posed a threat to thewaiting room environmentand he might upset otherpatients He had a ‘difficult’ disease(alcohol dependence) He might increase theworkload of the nurses He would probably notcontribute to the practice’sscore in the Qualities andOutcomes Framework (apoints-based system forpayment to NHS GPs, largelyfocussed on chronic diseasemanagement)We could add that he was notthe sort of patient they wantedto include on their list. And whatabout the woman with limitedEnglish? She failed to get help,despite the receptionist tryingto follow procedures. Thepractice was not bending overbackwards to help her, ratherthe reverse; there was anegative attitude at all levels: She could not understandthe receptionist She could not read theliterature, even in herown language She would need aninterpreter, which wouldmean a longer consultation,and additional cost to thePrimary Care Trust (PCT) orthe practice itself She might have one or more‘difficult’ conditions such16 nucleus christmas ‘ 08

homelessness and asylumas post-traumatic stressdisorder (PTSD), tuberculosis(TB), or HIVdefining ‘homelesspeople’The group includes not only thevisible ‘street homeless’ roughsleepers, but also people livingin hostels, bed and breakfastaccommodation, and people‘living with friends’. This entailssleeping on floors, and movingfrom flat to flat as their friends’patience or funds becomeexhausted. Homeless peoplehave become homeless for areason; often a relationshipbreakdown. This could beprecipitated by a drug andalcohol addiction or othermental illness, commonly foundin this group, both as a resultof their homelessness andas a cause of it. 3Homeless people are far morelikely to suffer from learningdisability, making them morevulnerable and less able to seekhelp assertively. 4 Most of thefailed asylum seekers discussedbelow will also be homeless inthis latter sense, and indeedsome will be sleeping rough.Homeless people do not usuallyhave a telephone, and they findappointments difficult to keep.Some larger cities have servicesrun by the PCT dedicated to theneeds of ‘socially excluded’people.asylum seekers andrefugeesIn addition to about 25,000 whonow enter the UK each yearclaiming asylum, 5 there are anestimated 300,000 or moreasylum seekers who have notyet been granted permission tostay. Their fate is in the handsof the UKBA, as well as theAsylum and ImmigrationTribunal (the court that hearsappeals and makes finaldecisions). After receivingpermission to stay in the UK,asylum seekers are known asrefugees. They become entitledto the same rights and benefitsas UK citizens, and they areable to apply for citizenshipthemselves.The mental health needs ofrefugees and asylum seekersare complex and serious. Inparticular, PTSD has to beidentified or excluded. It isoften accompanied by otherpsychiatric diagnoses,especially major depressivedisorder. Good support froma mental health service isimportant, as there are veryspecific psychologicaltreatments for this condition. 6Torture, rape, and injuries suchas gunshot wounds carrynucleus christmas ‘ 0817

homelessness and asylumemotional as well as physicalconsequences.People from sub-Saharan Africa(eg the Democratic Republicof Congo, Zimbabwe, Angola)are more likely to have HIV,for which specialist care isessential. HIV positive patientspose no special threat toprimary care, provided thatstaff members know aboutthe condition and precautionsagainst blood-borne viruses.TB is a significant disease invulnerable people. Althougheasily treated, a high index ofsuspicion is required, so that allpotential cases are referred forscreening at the local chestclinic. Asylum seekers arenormally screened at the portof entry, and they may befollowed up at their dispersalarea by public health nurses.Other health issues of thisgroup include poor nutritionand the physical consequencesof torture, such as brokenbones and gunshot EnglishproficiencyBoth asylum seekers andrefugees are likely to havelimited English proficiency(LEP), such that they need aninterpreter in order to accesshealthcare. It is a requirementof all NHS providers to offer aninterpreter when needed.Although this is a specific rightfor patients, the correspondingduty on NHS organisations israther vague; I usually cite theRace Relations Acts and theDisability Discrimination Acts.Organisations have differentways of meeting this obligation.Some, specialising in the care ofasylum seekers and refugees,have a dedicated group ofinterpreters on call. Otherswill be able to call on a locallyorganised interpretationservice, while for most it willbe a commercial telephoneinterpreter service. These areof course always available, andwhile they may be ‘second best’to a live and trained interpreter,they are far better thannothing, and would be quiteappropriate for our scenario.Practices in areas whererefugees and asylum seekerslive should ensure that theirstaff have some training in theneeds of people with LEP.Clinical personnel need trainingin working with interpreters,as the consultation is quitedifferent when a third person isinvolved. Many medical schoolsare beginning to include thisin their consultation skillsteaching programmes. If yoursdoes not, why not make arequest through your staffstudentliaison process?failed asylum seekersWhat about ‘failed’ asylumseekers? People who haveexhausted the appeal process intheir quest for asylum will havereceived a letter from the HomeOffice informing them that theyare no longer entitled to18 nucleus christmas ‘ 08

homelessness and asylumhousing support or even NHScare apart from in anemergency. However, the rulingof the High Court in April 2008 2overturned this unfortunateDepartment of Health directive.The ‘Still Human Still Here’campaign 7 is seeking to changethe law to extend support tosuch people.For the present, generalpractitioners have considerablediscretion in how they chooseto apply the rules, and they areable to ensure this group istreated with dignity andcompassion. There are bothpublic health and humanitarianarguments for providing properhealthcare for destitute asylumseekers. Of course, thegovernment is responsible formanaging limited resources, butthere is no evidence that theNHS is being exploited, ratherthe reverse. The financial costof extending NHS care to thisgroup is a tiny fraction of theNHS budget.a ChristianperspectiveGiven the legal frameworkI have outlined, you mightask, why should there be aparticularly ‘Christian’ take onthis? Despite the law, there is ahuge variation in the way healthprofessionals approach thesevulnerable groups. Jesus isdescribed as having‘compassion’ 8 – a word withdeeply visceral overtones,coming from the Greek wordsplanchnizomai, ‘to be moved asto one’s inwards (splanchna), tobe moved with compassion, toyearn with compassion’. 9 Hencein older versions of the Bible,‘bowels of mercy’. Can we sharethis degree of commitment?Does our colour blindinterpretation of the Bible failto see the Mediterranean Jesus,the black Simon of Cyrene, theblack Ethiopian cabinetminister, and the many differentraces comprising the earlychurch? 10,11 Have you everturned a blind eye todiscrimination? By doingnothing, you are complicit! Mostmedical schools have anorganisation supportingrefugees – perhaps you mightjoin it. Christians can be ‘salt’and ‘light’ beyond the comfortof the Christian Union or CMFgroup! Maybe there is a churchbased‘drop-in’ for destituteasylum seekers – your helpmight be much appreciated.Maybe your own church needsto be informed of the facts. 12Many asylum seekers areChristians – some have beenpersecuted for their faith.Welcome them. Others comefrom an Islamic culture, but arevery open to our friendship.Do not ignore them.Likewise, reflect on yourattitude towards those patientsin the admission ward withdeep vein thrombosis andulcers from injecting drugmisuse, or alcoholic hepatitisand cirrhosis. Unless yousubscribe to the ‘they get whatthey deserve’ theory, maybethey are rather the modernequivalent of the many ‘lepers’whom Jesus met, and touched. 8Peter Campion is emeritusprofessor of primary careat Hull York medical schoolREFERENCES1. Wright N. Homelessness: Aprimary care response. London:RCGP, 20024. Davies R, Campion P, Oakes P.Learning disability andhomelessness. Br J Gen Pract.2002;52:234,55. Mk 1:41, 6:34, 8:2; Col 3:129. Acts 2:5-1111. Hays JD, Carson DA (eds). FromEvery People and Nation: abiblical theology of race.Leicester: IVP, 200312. christmas ‘ 0819

SSM: healthcare for the homelessAbi Perini, Stephanie Wells and Sarah Nathanielwere challenged to be compassionateHomelessness isunavoidable. It is foundin every city centre, highstreet and hospital. As medicalstudents, we consider the roleof medicine in this ‘social’ issue.As Christians, we know thatJesus would be among thesepeople, tending to their needs. 1We investigated the servicesavailable for the homeless inCardiff during our third yearspecial study module (SSM). Togain an understanding of theirproblems, we visited a numberof healthcare providers andsocial projects. Our preclinicallectures gave us a theoreticalunderstanding of healthinequalities, but these conceptsbecame devastatingly real asour SSM progressed. Eventhough the NHS ethos ishealthcare at the ‘point ofneed’, the homeless mustnegotiate numerous obstaclesto access this care.compassionatewitness?Healthcare professionals areamongst the most accessibleforms of help for the homeless.However, an overwhelmingmajority of the homeless peoplewe met reported theirencounters with health servicesas ‘negative’; many felt judgedand dismissed. We werechallenged to consider if we,Christian medical students, fellinto this category. In the personof Jesus, we see the reality ofGod’s love for the poor, thefatherless and the widowed. 2‘Whatever you do for the leastof these, you do for me’, 3 hesaid. The places where we workand worship should beapproachable points of nonjudgmentalassistance.We all started this SSM withsome experience of workingwith the homeless, through ourchurches’ soup kitchens.Despite this, none of us reallyfelt comfortable approaching ahomeless person on the streetor in hospital. This wasprimarily because we wereafraid of not knowing what tosay or how to relate to them,and of being unable to help.Most of all we felt the guilt ofso often just walking straightpast them.beyond stereotypesThe opportunity to buildfriendships with homelesspeople was the highlight of ourproject. One man made a lastingimpression on us. He hadrecently been released fromprison and was struggling withfeelings of depression afterseparating from his wife. We gotto meet her, and by the end ofthe project we saw progress inboth their lives as they tried toget a flat of their own together.The more time we spent gettingto know homeless peoplepersonally, the more ourcompassion for them grew.We witnessed humanity in itsmost broken forms and we sawfirsthand the vicious cyclesof psychological, medical andsocial problems. Recurrentthemes in their lives includedrelationship breakdowns,problems after leaving fostercare, unexpected redundancyand substance misuse.We spent time with thespecialist homeless GP andnurse, as well as other membersof the multidisciplinary team.It was encouraging to see howGod had placed people withsuch passion and gifts withinthese specialist services inCardiff. It was also a privilege toobserve their wisdom, expertise20 nucleus christmas ‘ 08

SSM: healthcare for the homelessand resolve. Rather than alarger number of tailoredservices, we think there is agreater need for communicationbetween existing services andan awareness of the needs ofhomeless people. We now feelable to approach a homelesspatient on clinical placementswith greater confidence and wecan recommend appropriateservices.organising theprojectOur advice would be to look intowhat healthcare services areavailable for the homeless inyour area. This will help you toidentify specific problems thatthe homeless population andhealthcare professionals maybe facing, which are possibleareas of research. Secondly,find local healthcaredesperation in some of thestories we heard was a reminderthat we must draw on God’sstrength rather than our own.As ambassadors of Christ,we are called to seek justiceactively for the poor and brokenaround us. 5 Bringing the workof this project before God gaveAll this happened because wetook the opportunity to ‘designa project of personal interest’for our nine week SSM. We foundsuitable contacts after monthsof research; we then determinedthe aims and objectives andbegan work, with supervisionfrom a medical school tutor. Wedesigned one questionnaire forhomeless people and anotherfor GPs in Cardiff, to ascertaintheir knowledge and opinion ofhealthcare service provision forthe homeless. We also comparedthe average length of GPconsultations for housedpatients compared to homelesspatients. Assessment of theSSM was through individualwritten reports.You could organise a similarSSM at your medical school too.professionals with a specialinterest in homelessness,as they may be able to help.God of the brokenThrough spending time withmarginalised people in oursociety, we learnt more aboutGod’s loving character. In Mark’sGospel, 4 Jesus met Bartimaeus,a blind man begging by theroadside. Despite the crowd’sscorn, Jesus had compassion onhim. This story challenged andinspired us throughout ourproject. The depth of humanus a new perspective on ourresponsibility as Christians andmedical students to be salt andlight in this world. 6Abi Perini and StephanieWells are clinical students,and Sarah Nathaniel isintercalating at Cardiffmedical schoolREFERENCES1. Lk 9:112. Zc 7:103. Mt 25:404. Mk 10:46-525. Mi 6:86. Mt 5:13-16nucleus christmas ‘ 0821

serving the homeless with BarnabusAndy Meeson goes out with the medical vanBarnabus 1 is a Christiancharity in Manchesterthat aims to share thegospel of our Lord Jesus Christwith homeless people,prostitutes and prisoners.During the day, itsheadquarters, ‘The Beacon’,provides breakfast, washingfacilities, Bible studies,friendship and advice. Eveningssee volunteers descend on thestreets from minibuses, offeringcompanionship, food, drink, andmedical advice or treatment.Two years ago, I startedvolunteering once a week.I turned up on my first nightexpecting to be nice and chatty,and perhaps give out drinks.To my surprise I was asked, ‘areyou the doctor?’ After explainingthat I was only a student, I wasreassured that was ‘goodenough’ and I was shown tothe medical van along with twonurses. After a time of prayer,God had provided them withpeople to run a medical van, andI turned out to be one of them!medical needsaboundI have seen a multitude ofmedical needs in the people weserve. The usual complaints arefoot lesions, mainly fromwalking the streets all day inpoorly fitting shoes, throughManchester’s infamous wetweather. Other commonpresentations are injuriescaused by drug or alcoholabuse, such as abscesses atinjection sites, broken needlesin veins, or head wounds fromblackouts and seizures. We alsosee complaints ranging fromchest pain to depressivesymptoms – much like a GPsurgery or hospital accident andemergency (A&E) department.Ultimately, the treatment wecan offer is limited (we cannotprescribe, for example), soour role is mainly advisory.Very few GPs in Manchesteraccept patients without anaddress (I currently know ofonly one). The local A&Edepartment, I am told, oftentreats the homeless withirritation and cynicism. So weare frequently their first portof call, along with NHS primarycare drop-in centres.Primary care access is not theonly issue the homeless face;a big problem, in my opinion,is the homeless person with achronic disease. They will oftenmiss appointments becausethey have no fixed address toreceive letters. A particular manwith type one diabetes comesto mind; he presented with alarge foot ulcer having nottaken insulin for years.One thing I am certain of is thatthe people I come into contactwith at Barnabus do not receivethe same level of healthcare asI would. Illness prevention isneglected in this group; insteadcrisis management and hospitaladmissions are all too often themainstay of medical care.see their spiritualneedThe most important thing that Ihave learned is that these peopleneed to be told about JesusChrist. We can look after them;22 nucleus christmas ‘ 08

serving the homeless with Barnabuswe can feed and clothe them; wecan offer friendship; and indeedwe should. However, unless wetell them why we are doing this,unless we tell them about thehope we have in Jesus, then wedo not love these people as weshould. In fact, would we not justbe providing momentary relief ina life headed towards an eternityin hell?Manchester’s streets, humanlyspeaking, are a pretty hopelessplace. People are sleepingrough, trapped in viciousaddictions to drugs and alcohol,while vulnerable women sellthemselves for sex. Someexperience this horror for afew weeks, others a few monthsand some for many years.The only true hope for thesemarginalised people is ourmerciful God and Saviour.He enables us truthfully andwholeheartedly to encouragesomeone battling with alcoholaddiction to have hope, that allis not lost. Because we knowthat God is powerful and good –he is sovereign over all and withhim all things are possible. 2I see and hear of God savingprostitutes, pimps, addicts andthe homeless; I am repeatedlyreminded of God’s amazinggrace. He graciously humblestake action!Why not ask your local church about opportunities to serve thehomeless? You could even encourage your CMF group to volunteertogether! Here are a few websites to get you started:■ Crisis - for homeless people; it delivers services and campaignsfor change.■ Shelter - providing advice and advocacy for homeless people.■ Centrepoint - supporting homeless young people.■ Homeless UK - www.homelessuk.orgInformation on services, publications and training to dealwith and convicts me of my sin.For we are all sinners, rebelsdeserving an eternity in hell,who God graciously enables toturn and trust Jesus with emptyhands, to be justified throughhim. 3,4 Praise be to God!In truth, the mission of Barnabusis hard work – not a long list ofconversions. Many people are notinterested in the gospel; it seemsfoolish, or they are moreinterested in the free food. Theyare often aggressive andintimidating; although we arelooked after by our friends onthe street, there have beenhostile and even violentincidents. Evangelising oftenfeels awkward or forced so it iseasier just to patch them up andlet them go. On some nights,Barnabus seems so weak and itswork like a drop in the ocean. ButGod continues to work throughus to bring glory to his name,and so we echo Paul’s words:But he said to me, ‘My grace issufficient for you, for my poweris made perfect in weakness.’Therefore I will boast all themore gladly about myweaknesses, so that Christ’spower may rest on me. 5Andy Meeson is a clinicalstudent at Manchestermedical schoolREFERENCES1. Lk 1:373. Is 53:64. Rom 4:22-255. 2 Cor 12:9,10nucleus christmas ‘ 0823

Christian prayer for healingAndrew Fergusson considers recent events at LakelandMost of us heard aboutthe supernaturalphenomena claimed atLakeland, Florida earlier thisyear at events organised byFresh Fire Ministries, and led byTodd Bentley, the flamboyant,tattooed Canadian evangelist.It was said people were healedof all sorts of diseases anddisabilities, and it was evenbeing suggested that peoplewere being raised from thedead. Was this a wonderfulrevival? Or was it a mixture ofthe good, the bad and the ugly?Those questions may partly beanswered now because ToddBentley has stepped down fromministry after an ‘unhealthyrelationship’, 1 and things seemto have gone quiet, but thisarticle will review the Lakelandphenomenon before moving toa wider consideration of prayerfor healing.early comments fromthe EvangelicalAllianceCMF is a member body of theUK Evangelical Alliance and wasconsulted about an appropriateresponse to the early reportsfrom Lakeland. We endorse whatGeneral Director Joel Edwardswrote in an open letter on 10June: 2I suspect that many ofyou have watched withinterest the recentdevelopments in Lakeland,Florida. Unusual thingshave been taking placein Todd Bentley’schurch, andthey now seemto be spreadingto other partsof the world,includingthe UK.I’ve spoken to a number of ourmembers who are overjoyed atwhat they perceive to be thelatest outpouring of God’s spirit.Others, though, have expressedtheir concern at what ishappening and particularly thekind of appeals that have beenmade on TV and the internet.Inevitably, all of this reminds meof the struggles we all had at theAlliance at the time of Toronto.And I simply don’t yet know howI feel about all that is going on inFlorida. There are aspects thatmake me rejoice, and others thatmake me uneasy. However, atthe time of Toronto, I drew upthe following list of principlesthat it seems to me haveenduring relevance. I share themagain with you now so thattogether we can remain unitedaround our one common cause:the gospel of Jesus Christ.1. Evangelicals should makeevery effort to measure allspiritual phenomena bybiblical criteria. In every case,the devotional hallmarks ofholiness, prayer and witnessprovide reliable indicators ofauthentic moves of God.2. We also acknowledge that thecurrent phenomenon is notnew. During the 18th, 19th24 nucleus christmas ‘ 08

Christian prayer for healingand early 20th centuriesrevivals associated withrespected figures such asJonathan Edwards, Wesley,Whitefield and the Jeffreyswere also characterised byunusual events whichattracted controversyand blessings.3. We rejoice with those whotestify to a deeper level ofcommitment and joy as a resultof their experience but wouldequally urge them to avoidexcessive behaviour which maydiscredit the gospel or distancethose who genuinely seekan encounter with God.4. Whilst we would cautionagainst indiscriminateenthusiasm, we would equallyurge evangelicals to avoidpreclusive or condemnatorybehaviour which dismisses allunusual events out of hand.5. Finally, we would advocatethe Gamaliel principle; if thephenomenon is genuinely ofGod it will certainly bearlasting fruit.another gospel?Edwards shows twin concernsfor truth and for unity.Internationally respectedevangelical leader RT Kendallwas prepared to risk the latterin his concern for the primacyof truth, as this extract from anarticle (written before Bentley’sdeparture) shows: 3What complicated things mostof all was that people wereapparently being healed.At last count there were 37resurrections from the dead. Ifonly one of them had a coroner’sdeath certificate it would be avery serious matter to say thatwhat was going on there was notof God. The fact that ABC newscould find no documentaryevidence of a miracle was notenough to sway me one way orthe other. I was even prepared –for a while – to overlook theclaim that the angel Emma is thesecret explanation for thespecial revelations and miracles.I believe in angels. What if Emmawere a part of the ‘yuk’ factor?But a funny thing kept grippingme. It would take even morecourage to say that the Lakelandphenomenon is not of God. Did Ihave the courage to say this?After all, I was reluctantly comingto the conclusion that it was notof God, but would I say it?Yes. It comes to one thing at theend of the day: is the Bible trueor not?The article continued with acritique of what was nothappening at the meetings, aswell as a critique of what was,and it all led Kendall to conclude‘I can only call this “anothergospel” as in Galatians 1’.The retrospectoscope is a veryuseful instrument – it is alwayseasier to make diagnoses withhindsight! But credit to thesetwo leaders for their wiseforesight and for the courageof their convictions.Christian prayerfor healingAs we – probably – put Lakelandbehind us, we should stillconclude that Christians,including and perhapsespecially Christians inmedicine, should pray forhealing. The rest of this articlewill analyse that whole issue,with much summarised from myCMF book Hard Questions aboutHealth and Healing.healing miracles inthe Bible – a medicalperspectiveDecades ago, Dr Peter Mayanalysed the characteristicsof Christ’s miracles of healingand of the others seen in theBible and concluded: 4 The conditions were obviousexamples of gross physicaldiseasenucleus christmas ‘ 0825

Christian prayer for healing They were at that timeincurable and most remainso today Jesus almost never usedphysical means The cures were immediate Restoration was completeand therefore obvious There were no recordedrelapses Miracles regularly elicitedfaithThese seven characteristicsgive us a New Testament goldstandard for defining healingmiracles. Contemporary claimsfor miraculous healing can beevaluated against this healing miracleshappen today?Later in the book, 5 I describe anobjective approach for Christiandoctors to use in evaluatingclaims for miraculous healing.First line questions include: What was the medicalversion of the story? What was the precise natureof the diagnosis? At what time did recoverytake place? Were any treatments beinggiven at the same time?Depending on the answersto these, a second level ofquestions may be needed.For example, concerning thediagnosis: On what basis was thediagnosis made? How reliable were the testsperformed? How reliable were theobservers conducting thetests? Have experts checked theresults? Could there be otherexplanations for the results?During controversies abouthealing miracles in the early1990s, I was one of three CMFmembers (each then atdifferent positions on the‘charismatic’ spectrum) whoreviewed current claims, andconcluded ‘…between us, wedid not find a single case thatunequivocally satisfied ourstrict criteria for a…miracleof healing’. 6But each of us had excitingpersonal stories of answers toprayer for healing (and the least‘charismatic’ of us had the beststories!). We christened them‘Tales of the Unexpected’ aftera TV programme popular at thetime, and they led us toconclude that, yes, Christiansshould pray for healing.Before I turn to the questionof how we do that, it will behelpful to list some of thecategories that account for thedifferent interpretations thatboth medical and non-medicalChristians may hold: 7 Was the diagnosis wrong? Was there spontaneousremission? Could the diagnosis havebeen hysteria orpsychosomatic illness? Was there just a genuinemisunderstanding? Is it a case of exaggeration,half truth, or frank lie?how shouldChristians pray forhealing?I stated above that although welonged to see a genuine NewTestament, gold standardexample of a healing miraclewe had not done so. For me atleast, five years later thatremains true. But my responseis not to assume therefore thatGod doesn’t do miracles today.One of the dangers there iscreating a self-fulfillingprophecy: God does not dohealing miracles; therefore I willnot pray for them; thereforeexciting answers to prayer forhealing (or even miracles) areless likely to happen; thereforemy doubt is reinforced;therefore I will not pray…!26 nucleus christmas ‘ 08

Christian prayer for healingRather, I am stimulated to praymore. I believe that prayer forhealing is no different fromother prayers. However, weshould be particularly sensitiveabout how we provide it. TheBible gives us vital help inJames 5:13-16:Is any one of you in trouble? Heshould pray. Is anyone happy?Let him sing songs of praise. Isany one of you sick? He shouldcall the elders of the church topray over him and anoint himwith oil in the name of the Lord.And the prayer offered in faithwill make the sick person well;the Lord will raise him up. If hehas sinned, he will be forgiven.Therefore confess your sins toeach other and pray for eachother so that you may be healed.The prayer of a righteous man ispowerful and effective.There is no space to do otherthan summarise the principlesthis passage reveals. Christianhealing: 8 Is available for all Should be patient centred Should be practisedresponsibly Involves prayer May involve symbols Is associated with faith Is associated withforgiveness of sinApplication of these principlesin church contexts willobviously depend on thetraditions and practice there.I believe they can also beapplied, occasionally and verycarefully and sensitively, in thehealth professional context, butwith these vital emphases: 9 The doctor must clearlychange role The patient must giveconsent That consent must truly befully informed The doctor should reassurethat the prayer is not solelybecause of despair Touch is unnecessary andinappropriate The doctor should returnto role before theconsultation endsthe Gamaliel principleFollowing that briefconsideration of aspects ofChristian prayer for healing, letme return to a media enquiryabout whether we believedpeople were being raised fromthe dead at Lakeland. Myresponse was: ‘Yes, God cando anything – but show usthe evidence’.To the Evangelical Alliance, weand others advocated theGamaliel principle mentionedabove. In Acts 5 we read thatbecause of healing miraclesperformed daily through Peterand the apostles, they werebrought before the Sanhedrin,the Jewish ruling council. Oneof the Pharisees, Gamaliel, ‘whowas honoured by all the people’,gave us this immortal principle,which helps us to valueevidence while believing ina God who does miracles:Therefore, in the present caseI advise you: Leave these menalone! Let them go! For if theirpurpose or activity is of humanorigin, it will fail. But if it is fromGod, you will not be able to stopthese men; you will only findyourselves fighting against God. 10Andrew Fergusson is CMFHead of CommunicationsREFERENCES1. www.freshfire.ca2. Edwards J. Florida Kendall RT. Lakeland? Leave ItAlone! Sorted 2008:Sept/Oct:84. Fergusson A. Hard Questionsabout Health and Healing.London: CMF, 2005:55-575. Ibid:86-886. Ibid:877. Ibid:88-918. Ibid:133-1369. Ibid:140,14110. Acts 5:38,39nucleus christmas ‘ 0827

climate change and healthJohn Lockwood presents a scientific and biblical overviewFrom a biblicalperspective, creation careis an integral part of thegood news of redemption andnew creation in Jesus Christthrough the Holy Spirit. One ofthe lessons Job had to learnwas that the created ordertestifies to the vast wisdom ofGod and therefore is a motivefor praising God. Psalm 19:1states ‘The heavens declare theglory of God; the skies proclaimthe work of his hands’.In the early days ofexperimental science in the 16thand 17th centuries many people,including distinguishedscientists, saw their pursuit ofscientific knowledge as beingfor the glory of God. A widelyheld idea was that God’srevelation comes in the form ofwhat could be described as twobooks: God’s works (science)and God’s word (the Bible). ThusGod’s creation can be expectedto yield some information aboutthe nature of God, and havinglooked at creation’s God, wethen look at the createduniverse with new eyes.There is now a wide consensusamong the world’s scientificcommunity that human activitiesare having an effect on theclimate. Global warming and theresulting impacts are among themost serious environmentalproblems facing the worldcommunity. This article starts byexplaining the science behindgreenhouse gas induced globalwarming. It then considers whyChristians should be concernedabout the human impact onGod’s creation, followed by areview of the main possibleeffects on human health.the naturalgreenhouse effectThe gases nitrogen and oxygen,which make up the bulk of the28 nucleus christmas ‘ 08

climate change and healthatmosphere, neither absorb noremit thermal long-waveradiation. Consider anatmosphere consisting only ofthese two gases. As the sun’sshort-wave solar radiationpasses through thisatmosphere, about 6% isscattered back to space byatmospheric molecules andabout 10% on average isreflected back to space fromthe land and ocean surfaces.The remaining 84% remainsto heat the surface.To balance this incoming solarradiant energy, the earth itselfmust radiate on average thesame amount of energy back tospace in the form of thermalradiation. Otherwise the earthwould show very marked longterm heating or cooling. Tobalance the absorbed solarenergy by outgoing thermalradiation, the averagetemperature of the Earth’ssurface should be -6°C. This ismuch colder than is actuallyobserved at 15°C.This difference can be explainedby the fact that, in addition tonitrogen and oxygen, theearth’s atmosphere alsocomprises clouds, water vapour,ozone, and carbon dioxide.These are the principalabsorbers of infrared radiationemitted by the earth’s surface.Only about 9% of the thermalradiation from the groundsurface escapes directly tospace. The rest is absorbed bythe atmosphere, which in turnreradiates the absorbedinfrared radiation, partly tospace and partly back to thesurface.This blanketing effect is knownas the natural greenhouseeffect and the absorbing gasesare known as greenhouse gases.It is called ‘natural’ todistinguish it from theenhanced greenhouse effectdue to gases added to theatmosphere by human activitiessuch as the burning of fossilfuels and deforestation. Itneeds to be stressed thatthe natural greenhouse effect(a major regulator of surfacetemperature) is a normal partof the climate of the Earth andthat it has existed for nearlythe whole of the atmosphere’shistory.human induced CO2emissionsConcern about the greenhouseeffect arises over two issues:how the natural greenhouseeffect may vary with time, andhow human activities mightenhance the natural effect.Since the industrial revolution,human activities have increasedatmospheric trace gases suchas carbon dioxide. Before thestart of the industrial era,around 1750, atmosphericcarbon dioxide concentrationhad been 280 parts per million(ppm) for several thousandyears. It has risen continuouslysince then, reaching 379ppmin 2005. The annual carbondioxide growth rate was largerduring the last ten years(1.9ppm/yr from 1995-2005) thanit has been since the beginningof continuous directatmospheric measurements(1.4ppm/yr from 1960-2005).nucleus christmas ‘ 0829

climate change and healthWhen glacial ice forms, smallbubbles of air are trappedwithin, creating a continuousrecord of atmosphericcomposition. By drilling throughthe Antarctic ice sheet, it ispossible to reconstructatmospheric composition overthe last 600,000 years. Thepresent atmospheric carbondioxide concentration has notbeen exceeded during the past600,000 years, and possibly thepast 20 million years.Several lines of evidenceconfirm that the recent andcontinuing increase ofatmospheric carbon dioxidecontent is caused by humancarbon dioxide emissions, andin particular fossil fuel burning.These human-induced carbondioxide emissions enhance thealready existing greenhouseeffect, causing global warmingand fundamental changes inclimate.rising temperaturesLargely as a result of increasingatmospheric greenhouse gasconcentrations, global meantemperatures have increased by0.7˚C since around 1900. Overthe past 30 years, globaltemperatures have risen rapidlyand continuously (at around0.2˚C per decade) to thewarmest level reached in thecurrent interglacial period, whichbegan around 12,000 years ago.Most climate model calculationsshow a doubling of pre-industriallevels of greenhouse gases isvery likely to commit the earthto a rise of between 2˚C and 5˚Cin global mean temperatures.This level of greenhouse gaseswill probably be reachedbetween 2030 and 2060.Long-range climate forecastslack detail because of the nonlinearchaotic nature of climatesystems. Warming is projectedto be greatest over land and atmost high northern latitudes,with Arctic late-summer icedisappearing almost entirelyby the latter part of the 21stcentury.why the controversy?Climate change studies in thelate 20th century were oftenhighly controversial, partlybecause some oil and othercommercial companies, toprotect their perceivedinterests, funded campaignsagainst the results of climateresearch. Climate research inthe 21st century has madeconsiderable advances.The Intergovernmental Panelon Climate Change (IPCC)comments that warming of theglobal climate system isunequivocal, in their latestassessment report. This is nowevident from observations ofincreases in global average airand ocean temperatures, 1widespread melting of snow andice, and rising global averagesea level. The report furthercomments that continuedgreenhouse gas emissions ator above current rates wouldcause further warming andinduce many changes in theglobal climate system duringthe 21st century that wouldvery likely be larger thanthose observed during the20th century.Clearly carbon dioxideemissions have to be reduced,but ‘by how much?’ is a recentsource of controversy. A 50%reduction of global emissionsbelow 1990 levels by 2050,widely considered to be the30 nucleus christmas ‘ 08

climate change and healthmost stringent achievabletarget, will not avoid majorglobal impacts. It is thereforebeing suggested that limitingimpacts to acceptable levels bymid-century and beyond wouldrequire an 80% cut in globalemissions by 2050. The UK hasrecently committed itself to an80% cut in greenhouse gasemissions by 2050. Such areduction would requirefundamental changes inlifestyles, which manycommunities and countrieswould find difficult.a biblical perspectiveThere are a number of reasonswhy Christians should beinterested in the environmentand in its care. Traditionallythese may be described asfollows.1. the earth belongs to GodGod created the earth. Weencounter this in the very firstwords in the Bible, but it alsopervades the whole ofScripture. As far as the biblicalwriters are concerned, this isundisputed. God’s creation ofthe world is never theconclusion of an argument, butusually the starting point ofother arguments. For example,God speaks through thepsalmist of not needing oursacrifices, ‘for every animal ofthe forest is mine, and thecattle on a thousand hills. Iknow every bird in themountains, and the creatures ofthe field are mine.’ 2 In John 1:3we read that ‘Through him allthings were made; without himnothing was made that hasbeen made.’ Paul, in Colossians1:16, emphasises the full extentof what God has created.2. God sustains the earthIt is not a foreign concept toChristians that God sustains hispeople in their daily walk withhim. There is also a clear sensein the Bible that God’s constantinvolvement is not just limitedto people, but it encompasseseverything. For example, Paulwrites, ‘He (Christ) is before allthings, and in him all thingshold together.’ 33. God created the earth goodThe account of the creation inGenesis 1 has as a refrain, ‘AndGod saw that it was good’. Thenatural environment is notbenign because one result ofthe ‘fall’ is that the earth is alsocursed. 4 Therefore the whole ofcreation, not just mankind, is inneed of liberation and recreation.5 We now see a fallencreation; nevertheless the earthis still capable of declaring theglory of God. Part of themeaning of the goodness ofcreation in the Bible is thatcreation witnesses to the Godwho made it, reflectingsomething of his character. 64. humanity created as stewardsIn Genesis we are told ‘The LordGod took the man and put himin the Garden of Eden to work itand take care of it.’ 7 FromGenesis onwards, men andwomen have been called to beGod’s workers in the world, tolook after it as he would, and topreserve it. Jesus expresses theessence of the kingdom of Godin two commandments: ‘…theLord our God, the Lord is one.Love the Lord your God with allyour heart and with all yoursoul and with all your mind andwith all your strength.’ 8 and‘Love your neighbour asyourself.’ 9Each of these commandmentshas implications with regard tonucleus christmas ‘ 0831

climate change and healthour concern for theenvironment. To love God mustsurely mean also to value hiscreation as he values it. To loveyour neighbour must surelyalso mean not to spoil theirenvironment by polluting it, orpushing them into poverty sothat they cannot maintain it.The World Health Organisation(WHO) estimates the global costof climate change to be ‘up to5% of the gross domesticproduct by the end of thiscentury’. 10 They furthercomment that ‘climate changethreatens to undermineprogress toward the MillenniumDevelopment Goals: povertycannot be eliminated whileenvironmental degradationexacerbates malnutrition,disease and injury’.impacts on healthAn increased frequency of hotextremes, heat waves, andheavy precipitation is likely.Scientists are confident that,by the middle of this century,many semi-arid areas (egMediterranean basin, westernUnited States, southern Africaand northeast Brazil) will suffera decrease in water resourcesdue to climate change.1. heat stressThe IPCC considers it very likelythat warm spells and heatwaves will increase in frequencyover most land areas and leadto increased risk of heat-relatedmortality, especially for theelderly, chronically sick, veryyoung and socially isolated. 1The WHO estimates forEuropean Union (EU) countriesthat mortality increases by‘1-4% for each one-degree riseof temperature above a cut-offpoint’. 11 Over 70,000 excessdeaths were reported fromtwelve European countriesfollowing the heat wave insummer 2003. In the EU, 86,000extra deaths are projectedevery year, with a global meantemperature increase of 3˚C,in 2071-2100.2. malnutritionFood security is another area ofmajor concern because ofdecreasing precipitation andincreased frequency of severedrought. Food productivity isprojected to decrease in theMediterranean area, southeastern Europe and centralAsia. Crop yields could decreaseby up to 30% in central Asia bythe middle of the 21st centuryleading to a worsening ofmalnutrition, especially inthe rural poor.3. disease transmissionAlready occurring shifts in thedistribution and behaviour ofinsect and bird species aresigns that biological systemsare responding to climatechange. This is leading tosignificant changes in infectiousdisease transmission by vectorssuch as mosquitoes and ticks.Climate change has a number ofhealth impacts, apart from thethree discussed above. The USCenters for Disease Control andPrevention has produced auseful summary table (table 1).It links weather events to healtheffects and to populations mostaffected – illustrating the WHOwarning that ‘health impacts willbe disproportionately greater invulnerable populations.’ 12what can doctors do?1. educateThe first step is to educateourselves about what scienceand the Bible say about climate32 nucleus christmas ‘ 08

climate change and healthtable 1: health impacts of climate change 13weather event health effects populations most affectedheat waves heat stress extremes of age, athletes,people with respiratory diseaseextreme weather events (rain, injuries, drowning coastal, low-lying land dwellers,hurricanes, tornadoes, flooding)low socio-economic strata (SES)droughts, floods, increased mean vector-, food- and water-borne multiple populations at risktemperaturediseasessea-level rise injuries, drowning, water and soil coastal, low SESsalinisation, ecosystem andeconomic disruptiondrought, ecosystem migration food and water shortages, low SES, elderly, childrenmalnutritionextreme weather events, drought mass population movement, general populationinternational conflictincreases in ground-level ozone, respiratory disease exacerbations elderly, children, those withairborne allergens, and other (COPD, asthma, allergic rhinitis, respiratory diseasepollutantsbronchitis)climate change generally; mental health young, displaced, agriculturalextreme eventssector, low SESchange. We can then inform ourcolleagues, churches, and widersociety about the healthimpacts. 14 Our advice topatients also matters; a gooddiet (less meat, less processedfood, local food) and walkingor cycling to work not onlyimprove health, but reducecarbon emissions as well. 152. moderateSmall changes in lifestyle bymany people can add up to amajor contribution. So we need toconsider our own carbonfootprints. Firstly, review yourtravel arrangements; for example,are all those flights reallynecessary? Secondly, assess yourenergy usage; does your homeneed more insulation? Thirdly,think about the food you eat. Hasit been air-lifted across theworld? Can you drink tap waterinstead of bottled water? Aprofessor of public health arguesthat our role in addressingclimate change is comparable tothat in combatting smoking; weshould be committed to both,setting a personal example. 163. advocateMany of us will haveopportunities to influence theorganisations we work for toreduce their carbon footprints.Those who are enthused canjoin in advocating for local,national and global frameworksto constrain carbon dioxideemissions. 17 For example, youcould get involved with theClimate and Health Council. 18Another starting point is to getyour local church to acttogether by forming anEco-congregation. Thenucleus christmas ‘ 0833

climate change and healthEco-congregation movementproviders a creation care kitfor churches with a simpleenvironmental audit, freeresources to encourage action,and an award scheme.uncomfortablequestionsIt is easy to look back atChristian slaveholders in the18th and 19th centuries and ask,‘how could they not see thatslavery was incompatible withthe gospel?’ What did they,and the Christian people whosupported them, think theywere doing? Will ourgrandchildren look back at us,as they wrestle with ecologicalissues, and ask why we couldnot see the Christianresponsibility for stewardshipof the earth?John Lockwood is a retiredsenior lecturer from theSchool of Geography at theUniversity of Leedsuseful resourcesChristian environmental organisations:■ Eco-congregations -■ A Rocha - Christians in conservation -■ Christian Ecology Link -■ John Ray Initiative - an educational charity to bring togetherscientific and Christian understandings of the environment■ Roach J, Roach R. Climate Change. Triple Helix 2008; winter:6-8books:■ Hodson MJ, Hodson MR. Cherishing the Earth: how to care forGod’s creation. Oxford: Monarch Books, 2008■ Houghton, JT. Global Warming: the complete briefing (3rd ed).Cambridge: Cambridge University Press, 2004REFERENCES1. Ps 50:10,113. Col 1:174. Gn 3:175. Rom 8:18-256. Ps 19, 29, 50:6, 65, 104, 148, Jb 12:7-10, Acts 14:17, 17:24-28, Rom 1:207. Gn 2:158. Mk 12:29,309. Mk 12:3110. Gill M, Godlee F, Horton R, Stott R. Doctors and climate change. BMJ2007;335:1104,515. Griffiths J, Hill A, Spiby J, Gill M, Stott R. Ten practical actions fordoctors to combat climate change. BMJ 2008;336:150716. Gill M. Why should doctors be interested in climate change? BMJ2008;336:150617. McMichael AJ, Friel S, Nyong A, Corvalan C. Global environmentalchange and health: impacts, inequalities, and the health sector. BMJ2008;336:191-418. nucleus christmas ‘ 08

fighting for doctors’ rights?Derek Munday suggests a biblical approachWhat? No more freeaccommodation and nopay increase to coverthe extra cost!Just when I thought life wasbecoming easier without thedemands of out of hours work ontop of a very pressured and longworking day, the governmentpiles on additional QOF 1demands!These could easily be thecomments of a Foundation 1doctor and a GP. Hidden withinsuch statements is theassumption that it is my ‘right’that working conditions, payand prospects should alwaysimprove. It is very easy to letindignation and feelings ofbeing used and abuseddetermine behaviour. But, canthe current culture of ‘rights’ever sit comfortably with aChristian, who by definitionhas given up their rights insubmission to the lordshipof Jesus Christ?Before we can begin to grapplewith the position a Christian intoday’s world should take, weare on much firmer ground ifwe are prepared to spend timeunderstanding the age in whichwe live, learning from historyand challenging the robustnessof our theology. It is outside thescope of this article to engagein an in-depth analysis of oursociety; however, there arecertain pointers that may behelpful.learning from historyChristians were influential inthe establishment of tradesunions in the 19th century as aresponse to the exploitation ofthe poor. However, by the firsthalf of the 20th century therewas a growing convictionamongst evangelicals,particularly those from nonconformistbackgrounds (iemembers of churches otherthan from Catholic or Anglicandenominations), thatinvolvement in politics andprotest was not something thata real Christian engaged in.Indeed in some evangelicalchurches, voting in politicalelections was frowned upon.I vividly remember an elderlyman in the church I attendedboasting that he had nevervoted in his life. For him thiswas a mark of his separationfrom the world, his love for Godand his commitment to Jesus.As a teenager, this did not seemright to me. I remember havinghuge discussions about politics,rights and trades unions –which were always regarded asungodly, if not downright sinfulorganisations.Such a position, from today’sperspective, seems extremeand probably the province ofthose on the margins of theevangelical church. However,many who were sympatheticto such views had a deep lovefor God. Among them wereprofessionals, some of whomwere involved in the influencesthat brought about thefounding of CMF. Onenucleus christmas ‘ 0835

fighting for doctors’ rights?consequence that still lives withus is that in 1967, when theAbortion Act was passed, hardlyan evangelical voice was raisedin protest. That would nothappen today.We live in an age that viewsthings very differently. But arewe right? 50 years ago suchan article as this would neverhave been considered. Theevangelical position that I havedescribed was, to some extent,a reaction to the ‘Social Gospel’that had developed at the endof the 19th century, influencedby liberal theology and therejection of the evangelicalbelief in the Bible as literallytrue and containing all thatwas needed for salvation.Polarisation ensued. Thingswere either black or white. Inmany ways those days weremore simplistic but also morededicated, self sacrificing andself denying than our own.In the eyes of many there was aclear separation between issuesto do with the world and issuesto do with church. For many, thelatter consisted of preachingthe gospel. Anything else wasonly valid if it enabled suchpreaching or evangelism.Nothing was good for its ownsake. Indeed, in the morereformed (ie Calvinistic) partof the church, a sort of ‘worm’theology had developed – allthat was not directly seen to befrom God, or the preaching ofthe gospel, was to be regardedas of no value. The best I coulddo was ‘like filthy rags’ 2 , incomparison to what Godcould do.a sense of vocation50 years ago the world was amore ordered place. There wasa sense of service and altruism.The word ‘vocation’ was incommon use, certainly for thoseentering the Christian ministry,or becoming missionaries andcommitting themselves to a lifeof service, and in some casesintense poverty. To some extentit is still understood today thatthose entering such a lifestyleand ministry will only do so outof a sense of calling. But inthe past, those entering theprofessions of medicine,nursing and teaching, wouldalso have been expected tohave a similar vocation,especially, but not exclusively,in Christian circles.Medicine being a vocation,rather than a job, led to a verydifferent mindset. Being adoctor defined me. It was notwhat I did, but what I was. Itwas a great privilege. My wholelife was to be spent in caringfor others, rather than seekingfor the best ends for myself.The great danger, of course,would be just to assume thatthis was in every way correct,because it sounds so full ofhigh principle. But there weredownsides. Like Christianministers, many Christiandoctors’ families suffered.Children could feel that theycame a poor second to theirfather’s care of everyone else inthe community. There was littlechallenge to a system thatoften needed to be challenged.Often Christians stood alooffrom the messy world of politicsand debate. There were some,however, who combined acostly vocational call, witha willingness to challenge thesystem and bring about positivechange. These, if their lives also36 nucleus christmas ‘ 08

fighting for doctors’ rights?reflected the love and grace ofGod, were men and women ofgreat influence. The late DameCicely Saunders, one of thefounders of the hospicemovement, was a good example.from vocation to jobIn the mid 1970s junior doctorsbegan to challenge the safety oflong hours and some very realsituations where juniors were,if not abused, certainly used bytheir consultant bosses againstwhom they had no means ofdefence. This led to thebeginning of the movementaway from ‘profession’ to ‘job.’Overtime was paid for the firsttime. A one in three rota (ieworking 9am to 5pm everyweekday plus every third nightand every third weekend) wasintroduced as the standard towhich every hospital should aimfor junior doctors. Juniordoctors’ pay increased.Nevertheless there was adownside. Free accommodationand food ended. In hospitalsall over the country, the juniordoctors’ mess was closed. Thishad been the meeting placeand centre of a supportivecommunity of colleagues. Itusually consisted of a diningroom where food was alwaysavailable free (frequentlyeven during the night), witha kitchen, a television loungeand often a library and a bar.Hospital management willinglytook back the accommodation,often turning it intoadministrative offices. The costof insisting on ‘rights’ was theloss of privileges. The culturehad moved from community toworkplace, from vocation to job,from the cost of vocation to thecost of rights.Was this the correct way to go?I do not know. There can beno right or wrong in thesecircumstances. This, after allis not a moral judgment, butrather a choice of culture,vision and work philosophy.Today, the Christian juniordoctor faces similar ifsomewhat different choices.It is probably true to say that,as in the mid 1970s, insisting onrights will mean losingprivileges. There is always atrade off. How do we decidewhat to do? The easiest answeris to find some legalisticformula by which we can workout what God wants us to do.Yet God does not look forpeople who follow formulas.He looks for those who seek forrelationship with himself. Jesusspent much more time in themiddle of crisis and difficulty,with those who were regardedas sinners by the religiouspeople of the day, than hespent in the synagogues ofthose who made a separationof the sacred and secular andtherefore regarded themselvesas set apart and spirituallysuperior. Jesus looked forrelationship with men andwomen, not sterile religiousobservance and legalisticformulas.the importanceof right theologyEvangelical theology can bevery reductionist. Part of theproblem for many of us broughtup in the latter half of the 20thcentury, was that evangelicalbelief had been reduced to asort of ‘lifeboat’ theology. Itsuggested that: ‘this life is onlynucleus christmas ‘ 0837

fighting for doctors’ rights?a testing ground for heaven. Weneed to be saved, thus gettinginto the lifeboat, so that wemay end up in heaven. Our onlyother role is to pull people intothe lifeboat with us so that theyalso may be saved. All else thatdoes not serve this purpose isof no value.’While the need for men andwomen to find God, and to findsalvation in him cannot begiven too high an importance,the problem with this approachis that evangelism becomes thenarrow objective of our lives.Everything that I read in theBible, however, seems tosuggest that true evangelism isthe result of the entirety of ourlives. It is not so much anexternal activity that we engagein but the consequent actionsof a life lived in dynamicrelationship, experimental faithand obedience to the Father.Evangelism is the inevitableresult of a life lived to the fullin relationship with God, in hisworld; recapturing the heartthat he expressed when seeingthe world before the fall, ‘Godsaw that it was good.’ 3Evangelism is the outflow ofa life filled with the Holy Spirit,fully engaged in God’s world, aswell as being a formal activity.But the formal activity is basedon the natural outflow of a lifelived in this way, never theother way around. In otherwords – we should live asJesus lived.what wouldJesus do?Firstly, he would not havefollowed a formula. He wouldhave spent time with hisheavenly Father, seeking his willand wisdom. Secondly, he wouldhave been where the peoplewere, no matter whether thereligious people of the dayconsidered them to be sinners,outcasts or even hated Romans.Thirdly, he would always belistening to what he believedthe Holy Spirit to be saying, andthen, as a man, needing to takethe step of faith to obey whathe believed he was hearing.In the same way, there is noformula about how we shouldbehave towards, or negotiatefor, what we perceive to berights and justice. We, likeJesus, need to seek theperspective and wisdom of ourheavenly Father. We then needto walk in obedience and aboveall humility. Unlike Jesus, we aresinful and we can get thingswrong. The man or woman whohas the confidence to stand andsay, ‘this is what I believe,’ whilehaving the security in God alsoto acknowledge to themselvesand others that they could bewrong, is powerful indeed.Such quiet confidence – rootedin the knowledge that God lovesus more than we can everunderstand, that he will gentlycorrect us and restore us, andthat he cares more about theissue than we do – leads to aplace of rest and security. But itdoes require us to walk in God’sgrace rather than legalisticobservance, to walk by faithrather than formula, andcultivate humility rather thanpride. Far from stamping us intouniform conformity, God will callus different ones to radicallydifferent activity over the sameissue. Some may be called to anintense secret life of prayer,some to great exposure andpublic profile. The key thing isto know his day-by-day leadingwhatever we are called to do.Derek Munday is apart time GP who leadsChristians in CaringProfessionsREFERENCES1. The Qualities and OutcomesFramework is a points-basedpayment system for GPs in theNational Health Service.2. Is 64:63. Eg Gn 1:1038 nucleus christmas ‘ 08

fearfully and wonderfully made:compliancyThe compliancy of skinenables it to adapt to itsenvironment. It has thecapacity ‘to flow aroundwhatever surface it contacts’. DrBrand, after spending ‘hundredsof hours researching theanatomy of living skin’, explainsthe compliancy of fat globulesbeneath the skin of the hand.The fat globules which areunable to preserve their ownshape are surrounded byinterwoven collagen fibrils.Where stress occurs in thepalm of the hand, for examplegrasping a hammer, fat cellsalter their shape in responseto the pressure. They becometightly gathered and envelopedby the firm collagen fibrils. Theresulting tissue, constantlyshifting, becomes compliantand takes on the shape of thehandle of the hammer.This biological propertyof compliancy is mirroredspiritually; the author usesthe analogy that a Christianrepresents a grasping hand.Do we become square to thosethings that are square andround to those things that areround? Through our complianttissue, an object is not requiredto fit the shape of our hand,as our hand adapts. The apostlePaul writes, ‘…I have become allthings to all men so that by allpossible means I might savesome’. (1 Cor 9:22b)We can often adopt a ‘one sizefits all’ method in evangelism,when in fact each person isunique and at a different stageof his or her spiritual journey.Some seek detailed answersto the issue of suffering forinstance, whereas others areencouraged by our simpletestimonies. Perhaps we canwisely learn to adapt our waysof evangelising to be ascompliant as the hand.I was initially concerned thatstriving to be a ‘compliantChristian’ could put us at riskof compromising our standards.But, after prayer, I feel convictedthat we cannot confusecompliancy with compromise.Through the Scriptures we seehow Paul accommodated Jewsand Gentiles within the limitsof God’s Word and his Christianconscience; he would nottransgress the standards of God:To those under the law I becamelike one under the law (though IThis article is inspired by achapter from Yancey P, Brand P.Fearfully and Wonderfully Made.Grand Rapids: Zondervan, 1987.The authors expand on the NewTestament analogy of the Bodyof Christ, linking it to thehuman body.myself am not under the law),so as to win those under the law.To those not having the law Ibecame like one not having thelaw (though I am not free fromGod’s law but am under Christ’slaw), so as to win those nothaving the law. (1 Cor 9:20b,21)May we be led by the HolySpirit in showing sensitivityto the needs of individuals inevangelism, such that they canreach an understanding of thegospel and come to know Christ.Colleen McGregor is aclinical student at ImperialCollege Londonnucleus christmas ‘ 08 39

how to read the Biblefor all its worthSiôn Glaze teaches us to read the Epistlesthe epistles: learning to think contextuallyThis series is summarised from FeeG, Stuart D. How to Read the Bible forall its Worth (3rd ed). Grand Rapids:Zondervan, 2003.Taking a patient’s historycan be daunting. Youthink you know how toget all the information and howto ask the awkward questions,but the nerves set in when thepatient is in front of you. Andyou realise how much youmissed out when you speak toyour consultant afterwards!We can do exactly the samewith the epistles. We read themconfidently and think weunderstand the entire message,but we rarely do.The epistles are all the books ofthe New Testament minus thefour Gospels, Acts andRevelation. They are split into‘real letters’ and ‘epistles’. ‘Realletters’ are those that werewritten specifically for therecipient (eg Hebrews).Conversely, the ‘epistles’ wereintended for the general public(eg James). However, thedistinction is not always clear,and in this article, ‘epistles’ willrefer to both. The epistles werewritten in the first century andthey were all occasional(‘arising out of and intendedfor a specific occasion’), 1 socontext is key.form an impressionWhen you meet a patient youinstantly form an impression ofhim. For example, does he lookill? This is even before you findout about his symptoms. Do thesame with the epistles. Readingthrough your chosen epistle inone sitting is important to seethe big picture. Try making noteson the following:1. Who are the recipients?2. Attitudes of the author3. Hints about the occasionalnature of the letter(eg specific events)4. Logical divisions betweensectionsTaking 1 Corinthians as anexample, here are a few pointsyou could pick out:1. Most of them were Gentiles(12:2)2. Paul is rebuking them (5:2)3. Paul has been informed byChloe’s household aboutquarrels happening (1:10-12)4. Some sections are moreobvious, eg sexual immorality(6:12-20). Look for clues, suchas the repeated phrase ‘nowabout’ (7:25, 8:1)presenting complaintsThe next step is to consider eachof your patient’s symptoms inturn. You need to find out asmuch as you can; simplyknowing that he has pain is notenough! Similarly, the epistleswere written for a reason. Theyoften addressed specific issuesimportant to the recipients, likethe symptoms of a patient.Pick one of the divisions youidentified: read it then re-read it ina different translation if possible.Make notes, paying attention tokey words and phrases. Themesemerging from the section on40 nucleus christmas ‘ 08

sexual immorality mentionedabove (1 Cor 6:12-20) include: yourbody is for more than just sex, itis a part of Christ’s body.drug, family, andsocial historyThese aspects of a medicalhistory place everything theyhave told you into context. Wealso need to form an ‘informedreconstruction’ 2 of the culturalcontext of the epistles.Finding out about medicationthe patient is currently takingwill help you pick up on medicalconditions that have beenmissed. Drug side effects mayplay a role in the presentingcomplaint. In the epistles, whatfalse doctrines can you seebeing fed to the Christians?How are they in conflict with theteachings of Christ and whateffects are they having on thelocal church? In 1 Corinthians6:12, for example, some wereadvocating that there were nosexual boundaries.A family history gives invaluableinformation about potentialgenetic linkages. Likewise, whatis the heritage of the recipientsof the epistle? Were theyformerly Jews or Gentiles?How might this affect theirinterpretation of the gospel?A social history provides amore holistic perspective of theimpact of the symptoms on thepatient’s day-to-day life. Howare we to make sense of the‘symptoms’ in the epistles unlesswe understand the day-to-daylives of the people in thechurches described?Encouraging monogamy in asexually immoral church is verydifferent in a society that seesnothing wrong with promiscuitycompared to a society wheremonogamy is celebrated. A Bibledictionary or the introduction ina commentary will help you putthe epistle into context.treatment planAfter taking their ‘patients’histories’, the authors of theepistles understood their‘patients’ diseases’. Inspired bythe Holy Spirit, they were able togive treatment. The question iswhy they prescribed what theydid. Consider each paragraph ofa section in turn to appreciatethe literary context. Thinking inparagraphs is fundamental ‘tounderstanding the argument inthe various epistles’ 3 . For eachparagraph summarise two thingsas concisely as you can:1. What is being said2. Why you think the author hassaid this, at this point in timehow to read the BibleYou should now have a clearerunderstanding of the epistle’sintended message. For example,in 1 Corinthians 6:12-17, Paulstates that sex is more than justa physical act for pleasure, andthat we must use our bodiesappropriately. Paul says this torebuke those who were sayingrandom sex was permissible.conclusionWe must not neglect asking theHoly Spirit for guidance whenreading the Bible. But havinga formula at hand, as you readone of the epistles, will help youreally to get to grips with itsmessages. This formula reveals‘God’s Word to them’ (exegesis) -those who originally read theepistles. The next step is tounderstand ‘God’s Word to us’ 4(hermeneutics). That is whatwe will consider in the nextinstalment of the series.Siôn Glaze is a clinicalstudent at Cardiff UniversityREFERENCES1. Fee G, Stuart D. How to Read theBible for All its Worth (3rd ed).Grand Rapids: Zondervan,2003:582. Ibid:593. Ibid:64,654. Ibid:70nucleus christmas ‘ 0841

Editor,Throughout my first year atmedical school, I was worryingwhether God actually wantedme to do medicine. So I foundSam Leinster’s article on‘Planning your Career’ a greatcomfort and full of practicaladvice.My mind was filled with doubts.What if I don’t get a job at theend of this? Why does everyoneelse seem to know what theywant to do? What if I make thewrong decision about mycareer? What if I have alreadymade the wrong decision? Thearticle reminded me that Godhas promised to guide me(Ps 37:23) and that God mostlyshows us our path one stepat a time (Ps 119:105), not ina massive lightning bolt ofrevelation.It also reminded me of theimportance of prayer. I’veprayed hundreds of times,‘Your will be done’, but I neveractually realised that thismeans I should be praying forGod to make his plans, ratherthan mine, happen.The article encouraged me totake time to consider my career,not just to fret. Also, if thingsdon’t turn out the way I thinkthey should, God may justbe poking me in a differentdirection than the one Ioriginally wanted – but truesuccess is fulfilling God’spurpose, whatever that turnsout to be.Liz McClenaghanBrighton and Sussex MedicalSchoolEditor,‘Evidence Based Faith’, made mequestion the roles of evidenceand reason in faith. The Biblesays, ‘Now faith is being sure ofwhat we hope for and certain ofwhat we do not see.’ (Heb 11:1)Faith is invisible, so surely itsessence is lost the momentevidence is used to justify it?I am not saying that faith andreason are mutually exclusive.Indeed, both have been givenby God, and acts of reason haveelements of faith as they arealways based on assumptions.But if faith was rational,Abraham would not have triedto sacrifice his son Isaac. (Gn 22)If faith could be explained,Nicodemus would have easilyunderstood what it meant tobe ‘born again’ (Jn 3:7).God wants us to trust in himand not lean on our ownunderstanding (Pr 3:5). Without asimple childlike faith, trust withno preconditions, it is impossibleto please God (Heb 11:6).Norris IgbinewekaKing’s College LondonEditor’s response,Throughout the Bible, faith isrooted in evidence and reason:He who had received thepromises was about to sacrificehis one and only son, eventhough God had said to him, ‘It isthrough Isaac that your offspringwill be reckoned.’ Abrahamreasoned that God could raisethe dead, and figurativelyspeaking, he did receive Isaacback from death. (Heb 11:17b-19)Abraham trusted God on theevidence of what God hadalready done; Isaac was anunbelievable gift given howold Abraham and Sarah were.In taking this step of faith,‘Abraham reasoned’ from whathe already knew of God, andthis was the basis of his actof faith.Hugh IpNucleus editor42 nucleus christmas ‘ 08

student servicesThese include literature, conferences, electiveadvice,international links and local group support.Reps can supply joining forms, literature, extra copies ofNucleus and information about conferences and activities.Further information is on the CMF website: from or feedback can be sent to the National Students’Committee through its chair, Lloyd Thompson, STUDENT REPRESENTATIVESABERDEENBELFASTBIRMINGHAMBRIGHTONBRISTOLCAMBRIDGECARDIFFCORKDERBYDUBLIN (RCSI)DUBLIN (TCD)DUBLIN (UCD)DUNDEEDURHAMEDINBURGHGALWAYGLASGOWHULL/YORKKEELELANCASTERLEEDSLEICESTERLIMERICKLIVERPOOLEleanor LoveDavid NeillyGillian BlayneySarah HarrisCaroline BellSarah AldousNancy LoadesJohn HawkinsSarah HoodTom DonaldsonJudith EwingRachel ChevassutHannah WaneIan LauOlubukola EshoRobert RadcliffeClara HoGrace HoRuth ChuaKyle KophamelEvangeline NgDavid JackSarah MacLeanGrant HarrisRuth PeacockGareth JonesVacantRichard WorkmanSam Botchey (Hull)Becca Harrup (Hull)Carmen Leung (York)Amy Watson (York)Charlotte MearsGethin PritchardBeks BayanaHelen RobertsonNing MaMatthew PlayerVacantTom BoaseBrendon SoMANCHESTERNEWCASTLENORWICHNOTTINGHAMOXFORDPENINSULAST ANDREW'SSHEFFIELDSOUTHAMPTONSWANSEAWARWICKLondonBART'S & LONDONKING’SIMPERIALUCLST GEORGE'SJuliette BrettellMatthew NewportLaura BellLisa HegartyRachel PeirceIan PopeLydia JoyJenny WaTom HargreavesGraham ThorntonSam McGinleyAbigail WhiteStuart HolmesBronte TorranceKatie GoodhartHannah WilsonRuth MargettsJonathan SunkersingVacantNicholas BradshawKatherine WalkerMike HaycockEnhui YongSarah Bempah-AgyepongLydia DimitryAlex HoNathan BrendishJames PocockRachel Owusu-AnkomahYvonne IgunmaCMFChristian Medical FellowshipPresidentSam Leinster MD FRCSChairmanTrevor Stammers MB FRCGPTreasurerAllister Vale MD FRCPGeneral SecretaryPeter Saunders MB FRACSHead of Graduate MinistriesKevin Vaughan MB MRCGPHead of International MinistriesVicky Lavy MB MRCGPHead of Student MinistriesMark Pickering MB BSHead of CommunicationsAndrew Fergusson MB MRCGPStudent ChairmanLloyd ThompsonCMF was founded in 1949 and has over4,500 British doctor members in allbranches of medicine and 1,000 studentmembers. We are linked with around 60similar interdenominational bodiesworldwide through the InternationalChristian Medical and Dental Association(ICMDA). CMF is also one of severalpostgraduate groups affiliated to theUniversities and Colleges ChristianFellowship (UCCF), and is a registeredcharity no. 1039823. Our aims are to uniteChristian doctors in pursuing the higheststandards in Christian and professional life- in evangelism, ethics and student andmissionary support.

christian medical fellowshipuniting and equippingchristian doctorsTo find out more, telephone 020 7234 9660 or visit our website, 6 Marshalsea Road, London SE1 1HLTel: 020 7234 9660 Fax: 020 7234 9661Email: Website: Medical Fellowship

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