The conflict of faith and medicine

Bad Faith: When Religious Belief Undermines Modern Medicine

By Paul A. Offit

Basic Books. 253 pages. $29.95

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In January 1991, Robert Ross, the deputy city health commissioner, received a troubling call from a woman whose granddaughter belonged to the Faith Tabernacle Congregation in North Philadelphia. As a member of the faith-healing church, her granddaughter was not vaccinated against measles, and she said other children at the church school had fallen ill. A month later, a 9-year-old girl at the school died from measles.

In a panic, Ross asked the pastor to immunize all children in the congregation. He refused.

"People with certain religious beliefs can also make decisions for those who don't share their beliefs," Paul A. Offit writes in his latest book, Bad Faith: When Religious Belief Undermines Modern Medicine.

Offit, the infectious-diseases chief at Children's Hospital of Philadelphia and codeveloper of a rotavirus vaccine, has waged a high-profile campaign for years against those who oppose immunization; earlier books examined the history of the anti-vaccination movement (Deadly Choices) and the persistent yet false belief that the MMR vaccine causes disease (Autism's False Prophets).

This time around, Offit explores the ideas cultivated by members of faith-based groups who reject all forms of medical treatment. Each chapter begins with a story about a child who dies from a preventable illness or a chronic condition left untreated. In numerous examples, he recounts how parents, highly educated and not, believed having faith would save their babies. It didn't. Their blind belief in divine power, he writes, simply meant suffering for their children, from diabetes, tumors, herpes, blood infections - and, in one chapter devoted to Philadelphia - measles.

The common childhood disease had been dramatically reduced through national vaccination programs beginning in 1963. Although Offit does not discuss it, cases began to spike nationally in 1989, prompting the federal government to recommend two doses of vaccine instead of one; it was another couple of years before infections dropped back to low levels.

Measles arrived in Philadelphia on April 20, 1989, Offit says, when a teen traveling back from Spain had a rash and then went to a concert at the Spectrum. The early cases were not a big concern. But it spread, and by the winter of 1990-91, the unvaccinated church community served as gasoline on the viral fire, with hundreds of congregants infected and transmission moving rapidly around the city.

Typically, one of every 1,000 children infected with measles dies. In Philadelphia's Faith Tabernacle congregation in February 1991, four out of 150 did. "That's a death rate of one in 35, worse than that found in any developing-world country," Offit writes.

It wasn't because the measles strain was unusual. Children were dying in higher numbers due to pneumonia or severe dehydration from vomiting - known complications from untreated measles.

When Deputy Commissioner Ross and his staff called more than 400 families of the congregation, they were shocked to discover none of the parents owned thermometers. Nor did they administer Tylenol to children with fever.

By spring, measles had turned into a Philadelphia public health nightmare, with cases in the suburbs, as well.

Despite widespread criticism, Faith Tabernacle's pastor, the Rev. Charles Reinert, offered that the outbreak was "drawing us all together as one body."

As a last resort, Mayor W. Wilson Goode obtained a court order to require all children in the city to be vaccinated. Baffled, Reinert tried to persuade the American Civil Liberties Union to take up the church's case. But the ACLU refused to fight against a mandate to protect the city's children from a preventable illness.

"In the 250-year history of the United States, no child had been vaccinated against his or her parents' will," Offit writes.

The outbreak was already slowing. By early June, it was over, but not before taking the lives of nine children (six from Faith Tabernacle and another congregation that rejected modern medicine, First-Century Gospel Church) and infecting more than 1,400 people around the city.

Offit finishes the measles chapter with a subtle suggestion that an outbreak of this magnitude could happen again under the right circumstances. He cites a 2013 study that found more than 30,000 American children have not been vaccinated against measles due to their parents' religious beliefs. (That number would be far higher if it included "philosophical" objections, which have been cited in the current outbreak, small by the standards of 1990, that began in California at Disneyland in December.)

Bad Faith begins and ends with the experience of Rita Swan and her husband, former Christian Scientists from the Midwest who relied on prayer to save their 15-month-old son from a bacterial meningitis infection. The Swans were cast out of their church after taking the sick infant to the hospital in a last-resort attempt to save his life.

Abandoned by her community and devastated by her son's death, Rita Swan became vocal about how followers of Christian Science were being misled about the implications of refusing medical help. Among other efforts, she teamed up with a pediatrician named Seth Asser; they coauthored a 1998 article in the medical journal Pediatrics that identified 172 children who lost their lives due to their parents' religious beliefs.

Their stories, as Offit summarizes them, are shocking:

"They found a 2-year-old boy whose treatable kidney tumor weighed six pounds and a 12-year-old girl whose bone cancer was the size of a watermelon. They found a 2-year-old girl who had accidentally inhaled a small piece of banana, in response to which her parents called a special prayer meeting while she struggled to breathe, turned blue, and died in front of them."

Although Offit makes a strong case against faith-based cures, he nevertheless devotes an entire chapter to the history of religion and its intersection with medicine. He points out that biblical writings about medicine predated medical advancements such as penicillin and antibiotics. And in a compelling point, Offit emphasizes how even Jesus embraced modern medical practices of his day. Loose interpretations have resulted in the beliefs now held by faith-based groups such as the Church of the First Born, the End Time Ministries, the Faith Assembly, and the Faith Tabernacle congregation.

The claims produced by these insular communities make it hard for followers to realize the danger they are placing their children in, Offit says.

When faced with the deaths - or blindness, deafness, or other types of impairments - of their children, these parents point to God.

Ultimately, that's what makes legal loopholes for these practices so troubling. Even in cases where parents have been found guilty of neglect or occasionally murder, religion usually protects them from punishment. Many never serve a day in prison.

As a positive example, Offit offers Oregon, one of five states that have made what he calls child abuse on religious grounds a punishable crime. He says instances of neglect by faith-based groups there have decreased. But that's not the case in most states, including Pennsylvania and New Jersey.

In closing, Offit contends the solution doesn't cost anything. It just requires outlawing "religiously motivated medical neglect."

Honest and fair, Bad Faith fails to leave any stone unturned - whether it be why faith-healing groups continue to promote these practices or roots of the religious theories against modern science.

Regardless of your faith, this is a fabulous book that's well worth the read.