Is Religion the Greatest Threat to World Peace?

With or without religion, good people can behave well and bad people can do evil;

but for good people to do evil — that takes religion.

Nobel laureate Steven Weinberg

The day we as a global nation choose to live for causes and not support ones that are worth dying for; will truly be a great day. Sadly it is a long way off. It will take tolerance and peace having to become more sacred than dogma and blind unquestioning arrogance for that to occur. When questions can be asked without having to fear for ones life, or risk being shouted down in the name of some religion…as they fear the questions (or maybe it is the answers the fear), that will be a day to treasure.

The religions that dominate our world today are made up of fossilized dogmas, that have been excavated from the mud of our past. They hale from a by-gone era when man created religion in an attempt to better understand his world. We now have science, evidence based research and rational questioning minds, which is the antithesis of many religions. This bygone dogma was forged in a world and culture so foreign to the one we live in today, but yet those beliefs are still held as sacrosanct and untouchable. As a result of this outdated dogma, evil deeds are allowed to breed, not by distorting or changing the teachings of scripture, but by obeying them. There is much material in every religious tradition that teaches violence, intolerance and hatred.

When a person believes, truly believes, that they know God’s will, they become almost impossible to reason with. Scientific research and evidence is thrown out along with rational thinking and the bath water. This is because most religions teach that faith – belief not supported by evidence – is not just acceptable but commendable, and is the sign of a virtuous person. Reasoning with a person in the light of the above becomes nigh impossible, as religious morality is not grounded in humans needs and desires, but in the will of god. Beliefs that weren’t based on evidence to begin with usually can’t be changed by evidence. Hence religious faith becomes very dangerous; when a religious believer chooses a course of action that’s evil or harmful, efforts to persuade them to stop will be futile. After all, if God has told them to follow a certain path, any opinion to the contrary is the devils work, and must be resisted, forcefully if needs be.

Religious leaders (and many of their followers), from all religions; oppose abortion, birth control, gay adoption, same-sex marriage, woman’s rights, euthanasia, to mention but a few — they want to control how people are born, marry, raise families, how they die, who they vote for, what to eat/not eat and which wars to fight. They want to barge into ones life during our most private moments and impose neigh, force and demand an adherence to their rigid, paternalistic creed. They know best how life should be lived, they have no qualms in seeking to intrude upon the lives of others at the most important and personal of moments.

Differentiating the evil that religion can perpetuate and the goodness in some people who practice religion seems fair up to a point, but how can one, for example, be both Catholic and good given the Vatican’s hundreds of years of torturing and murder, and currently, its favoring image over children? It is akin to being a good Nazi, which is exactly what its pope believes himself to be. When you base your “faith” in books that brim with divine violence, like the Old Testament, doesn’t that lead to more violence, at least in the defense of your “faith”

Sadly religion is never about what humans really need, but about what “god” supposedly needs humans to believe and do. The fact that religion is not about human needs is exactly what makes religion so pernicious. In other words, no matter what you believe, you do not have the right to hurt or curtail the rights of others, or to disproportionately benefit yourself at the expense of others.

It’s a far nobler a pursuit to wrestle with questions of ethics than to evade our responsibility and just parrot edicts that were written down thousands of years ago. It’s too easy to not have to really think about the consequences of our actions when we can just point to a book and say “but God said so.” We don’t understand maths because we take it on faith, in all other realms of our universe, we do not use faith as means of understanding its inner workings. Leaving it to faith is coping out, and it is the same as throwing up our hands and saying I don’t need to know, and deciding that some higher power will reveal all to us in good time. In my opinion, that stance does not get us any further as a species. It only leaves us standing still; unable to progress and make life better for everyone.

In closing let me end with a philosophical statement… which turned into a religious statement … and then totally ignored by religions…

‘Do unto others what you want done unto you.’

Confucius

557 BC, From the Analects 15:23

“One should always treat others as they themselves wish to be treated.”

3200 BC, From the Hitopadesa

MEDICAL RESEARCH – AN EVIDENCE BASED APPROACH TO GLOBAL HEALTH

A question posed by Jessica Taaffe on twitter, who is a TWIGH panelist, is my inspiration for this weeks blog. The question posed was: If you were to list three major research gaps for access to medicines what would they be? I posted 2 comments to that statement, the 140 characters per tweet, was not enough to fully weigh into the matter, so I am using this weeks post as a soapbox to expand further.

Firstly you might be asking what does this have to do with global health? In a nutshell, it has a huge impact, access to medicines, is dependent on the research that underpins it, it is the foundation on which medicine that we use stands. How firmly it stands depends on the strength of the research. If the road travelled to arrive at the end product is not evidence based (we will discuss the vagaries of this shortly), we then run the risk of having a flawed product, or even in some cases a product that never sees the light of day, (see my blog on Politics and Medicine).

The two comments I posted to twitter stated that evidence based medicine must be driven by independent clinicians, scientists and medical policy makers. Furthermore I stated that Levels of Evidence A (LOE – A) must be the benchmark. We cannot just be led by the large multinationals (Pharma and Medical Device Industries), they can most certainly push money into research, but the parameters of that research must be in the hands of independent clinicians, shared decision making can and must play a key role. This is a huge challenge but must be addressed, we need to claim back the labs and work alongside the drug and medical device industries

So what is evidence based medicine , why is it important and why do I say the we need to adhere to LOE -A?

Evidence based medicine grew out of critical appraisal, when Gordon Guyatt took over as the director of the internal medicine registry programme at McMaster University. He wanted to change the program so that physicians managed patients based not on what authorities told them to do but on what the evidence showed worked. It then appeared in an article in “The Rational Clinical Examination” series in Journal of the American Medical Association (JAMA) in 1992.

The strength of evidence is assessed by a specific grading system which, in fact, is quite simple. It combines a description of the existence and types of studies supporting a certain recommendation.

-Level of evidence A: recommendation based on evidence from multiple randomized trials or meta-analyses

-Level of evidence B: recommendation based on evidence from a single randomized trial or non-randomized studies

-Level of evidence C: recommendation based on expert opinion, case studies, or standards of care.

So the highest standard to attain is LOE – A, is this always the case? In 2009, a very interesting paper was published in JAMA, assessing the strength of evidence underlying the American College of Cardiology (ACC) and the American Heart Association (AHA) practice guidelines. They were reviewing recommendations to see if they were based on strong levels of evidence (LOE – A) and how much is based on “expert” opinion.

In only 11% of the guidelines published was LOE – A the benchmark, and most of the current guidelines included more than 50% of LOE – C as the standard! The authors correctly concluded that “expert opinion remains a dominant driver of clinical practice, particularly in certain topic areas, highlighting the need for clinical research in these fields”. I am sure if we had to review other areas of medical research we will be in a similar ballpark.

I can cite numerous examples from my own area of speciality where we have used certain drugs for years, with no studies definitely stating that they were beneficial to the patient, but there use was continued because of expert opinion, what drove that expert opinion is open to debate.

The Internet has also allowed incredible access to masses of data and information. However, we must be careful with an overabundance of “unfiltered” data. As history, as clearly shown us, evidence and data do not immediately translate into evidence based practice.

This is where the Cochrane Review stands the test of time, as it enable the practice of evidence-based health care, where health care decisions can be made based on the best available research, which is systematically assessed and summarised in a Cochrane Review. Cochrane Reviews are systematic reviews of primary research in human health care and health policy, and are internationally recognised as the highest standard in evidence-based health care.

In closing then, to come back to the original question; what three major research gaps for access to medicines:

  1. Research must be evidence based with LOE-A as the gold standard

  2. Research must be driven by independent clinicians, scientists and medical policy makers

  3. Research needs to be taken back to the labs and institutions who will research what is needed globally.

We would need large NGO’s such as the WHO and the European Research Council (amongst others) to monitor and guide where research needs to be focussed. We need to thank all scientists, inventors, and researchers who are motivated by the need to know, the thrill of discovery,and the desire to make a positive contribution to mankind as a whole and acknowledge the right of people to the common ownership of medicines/vaccines etc. which are basic to their common and individual well being, as to life itself.

As the cognitive linguist George Lakoff puts it, “Empathy is at the heart of real rationality, because it goes to the heart of our values, which are the basis of our sense of justice. Empathy is the reason we have the principles of freedom and fairness, which are necessary components of justice.”