Ideological Medicine: Serving Aims, not Humanity

A few weeks ago, the Centers for Disease Control (CDC) announced a new recommendation on AIDS prevention: uninfected people at risk of HIV transmission should take a pill – a particular antiretroviral drug – on a daily basis. This is referred to as “pre-exposure” prophylaxis.

There is a certain sadness in the prospect of an uninfected person indefinitely taking the same type of drug that HIV infected persons must take to prolong their lives – even before considering the expense, the prospect of serious side effects, and implications for drug-resistance down the line.

Not everyone feels this pill will turn the tide in actual practice, owing to the imperfect nature of the protection it provides, potential lack of adherence, and the fact that its protection could be offset by increases in risk-taking behavior (as was observed when antiretrovirals and post-exposure prophylaxis were introduced). Nevertheless, it is, in many respects, being heralded as a breakthrough.

In any event, this new recommendation – which amounts to a shift in emphasis – comes with a little noticed admission. CDC officials, as the New York Times relates, “have long been frustrated that the number of HIV infections in the United States has barely changed in a decade, stubbornly holding at 50,000 a year, despite 30 years of advice to rely on condoms to block transmission.”

Don’t tell anyone, but this basically means Pope Benedict XVI was right when he had the temerity to observe that condoms were not the solution to the AIDS crisis. For this, you recall, he was blistered as a dangerous threat to public health. What should we now conclude about our public health officials?

This failure must be passed over in silence because his larger point – that a humanization of sexuality is needed – is regarded as anathema. It is not even deemed worthy of emphasis by the authorities when serious morbidity looms large.

This is what the Italian bishop and noted bioethicist Elio Sgreccia refers to as “ideological medicine,” which stands in contrast to the traditional Hippocratic brand of medicine. It is concerned with power – with advancing an agenda that “ignores or circumvents the question of truth.” Ideological medicine, in his apt diagnosis, amounts precisely “to the exploitation of the medical profession as it is forced to carry out ideological aims, whether legalized or not, that are present in the society.”

The discipline of Public Health has been utterly co-opted in advancing the ideological aim of normalization. (You would be hard pressed, it must also be said, to name a profession that hasn’t been so co-opted.) Examples of this abound, but Dr. Vanessa Cullins, Vice President for “Medical Affairs” at Planned Parenthood recently provided one in blatant fashion, issuing the following boilerplate if not uplifting online video “guidance”: “In terms of sexually transmitted diseases, expect to have HPV once you become sexually intimate.”   

Or how about the New England Journal of Medicine, recently publishing an editorial claiming that “legalizing same-sex marriage can improve health and access to health care for LGBT people.” The reason? “LGBT people living in states that ban same-sex marriage, for instance, are more likely than their counterparts in other states to report symptoms of depression, anxiety, and alcohol use disorder.”

It is an open question as to whether or not the editor who granted space for such agitprop actually believes it to be a worthwhile medical contribution. Open too is the question of which would be worse: thinking it is, or thinking it is not, but acquiescing nonetheless.  What is clearly worthy of notice, however, is the implicit assumption that these symptoms – “depression, anxiety, and alcohol use disorder” – result from a failure to legalize same-sex marriage. 

Ideological medicine insists that these symptoms could not really, decisively, have anything to do with behavior itself (including any previously endured trauma). I read somewhere recently, from a source I trust, that the suicide rate is several times higher among young homosexuals than the national average. As far as I know, there is no technical remedy for that.                                

In each case, whether it is elevated risk of HIV transmission or of suicide, the pretense must be maintained that the underlying behavior is normative and healthy. The façade  that patients may be well served in this manner is vintage ideological medicine.

It would be far better, though far-fetched, if a disciple of Pascal were heading up the CDC.  Believing what he wrote in his Pensees would hinder professional advancement today, but it gets to the heart of the problem with the reigning philosophy of “risk reduction”:

It is dangerous to make man see too clearly his equality with the brutes without showing him his greatness. It is also dangerous to make him see his greatness too clearly, apart from his vileness. It is still more dangerous to leave him in ignorance of both.

Medicalized strategies of AIDS prevention manage to hold people in both too high and too low regard: too high in that they condone and facilitate all manner of behavior, seeing no need for restraint because man can do no wrong; too low in the belief that man has no capacity to change, and is irrevocably locked into destructive lifestyles.

To veer too far in either direction is to cultivate disaster. And we’ve veered very far.

The law written in men’s hearts, St. Augustine testified in his Confessions, is such that not even ingrained wickedness can erase it. It is not naïve to say that the hope stemming from this truth is more valuable than any pharmaceutical prophylaxis.

Yet that hope is dismissed rather than prioritized. Anyone so laboring to obscure the truth, Romano Guardini wrote, should clearly realize they are doing nothing less than “depriving man of his humanity”; even plainly evident truths are kept at bay because such a “realization would crush and destroy them”.

Matthew Hanley’s new book, Determining Death by Neurological Criteria: Current Practice and Ethics, is a joint publication of the National Catholic Bioethics Center and Catholic University of America Press.