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Opus Dei « Rantings
John Allen Jr's book on Opus Dei
OPUS DEI
An Objective Look Behind the Myths and Reality of the Most Controversial Force in the Catholic Church
JOHN L. ALLEN, JR.
November 2005
First Edition
To my grandfather, Raymond Leo Frazier, who died at ninety-two during the preparation of this book. He was the primary role model in my life, a great man, and, I believe, a saint. He taught me much of what I know about integrity, good cheer, and enjoying the simple things in life. He was also a first-class storyteller, some of which I hope has rubbed off. And to my wife, Shannon, for her patience and understanding, which at times during this project were tested to the limits of human endurance.
CONTENTS
Introduction
Section One: Essentials
Chapter One: A Quick Overview of Opus Dei
Chapter Two: Escrivá
Section Two: Opus Dei from the Inside
Chapter Three: Sanctification of Work
Chapter Four: Contemplatives in the Middle of the World
Chapter Five: Christian Freedom
Chapter Six: Divine Filiation
Section Three: Question Marks About Opus Dei
Chapter Seven: Secrecy
Chapter Eight: Mortification
Chapter Nine: Women
Chapter Ten: Money
Chapter Eleven: Opus Dei in the Church
Chapter Twelve: Opus Dei and Politics
Chapter Thirteen: Blind Obedience
Chapter Fourteen: Recruiting
Section Four: Summary Evaluation
Chapter Fifteen: The Future of Opus Dei
INTRODUCTION
If you want a guiding metaphor for Opus Dei, the spiritual organization founded in Spain in 1928 by Saint Josemaría Escrivá that has become the most controversial force in Roman Catholicism, think of it as the Guinness Extra Stout of the Catholic Church. It’s a strong brew, def¬initely an acquired taste, and clearly not for everyone.
Putting things this way immediately runs the risk of being superficial, not to mention giving offense, since Opus Dei is not a commercial prod¬uct but a spiritual path that aims at the sanctification of the secular world, a path followed with great fidelity and moral seriousness by some eighty-five thousand people worldwide and admired by millions of others. It is also bitterly opposed by a substantial sector of opinion inside and outside the Catholic Church. To compare Opus Dei to a beer could seem like a way of trivializing it. Yet the “Guinness Extra Stout” image captures some¬thing important about the role Opus Dei occupies on the Catholic stage, and it’s worth taking a moment to tease it out.
In an era when the beer market is crowded with “diet” this and “lite” that, Guinness Extra Stout cuts the other way. It makes no apologies for either its many calories or its high alcohol content. It packs a frothy, bit¬ter taste that has been compared by some wags to drinking motor oil with a head. Precisely because it resists faddishness, it enjoys a cult following among purists who respect it because it never wavers. Of course, if you think it tastes awful, its consistency may not be its greatest selling point. Yet while Extra Stout may never dominate the market, it will always have a loyal constituency.
To apply this image to the Catholic Church, the four decades since the Second Vatican Council (1962-1965) have also to some extent been marked by a “less is more” spirit. Broadly speaking, the thrust of Vatican II was to throw open the windows of the Church, updating and rejuvenat-ing it by returning to the gospel basics, offering a greater openness to the world, and promoting greater unity among the divided Christian family and with all of humanity. In the rites and rituals of the Church, there was a strong push for simplification, most notably the dropping of Latin as the principal language of worship and adopting the vernacular. Many tradi¬tional devotions and practices fell into disuse while spiritual disciplines such as the Friday fast were relaxed. Ecumenical and interreligious dia¬logue replaced apologetics as the primary way of interacting with people in other confessions and religious traditions. Priests and nuns often stopped wearing distinctive religious garb, fearing that it came across as a sign of privilege or a way of distancing themselves from the people they wanted to serve. In many sectors of opinion, the Church’s mission came to be understood in terms of promoting human and social development in the here and now, with too much talk about prayer and the sacraments seen as pie-in-the-sky spiritualizing. Memorization of doctrine gave way in much Catholic education to a more analytical and critical approach, and charitable activity was supplemented by attention to the structural di¬mension of global injustices and what has come to be known as “social sin.” All of these statements are caricatures of complex theological and ec¬clesial trends, but they indicate broad lines of development.
In this era of new ecclesiastical brews, Opus Dei offers a robustly classical alternative. Like Guinness, the “market share” of Opus Dei in global Catholicism is, given its outsize public image, remarkably small. According to the 2004 Annuario Pontificio, the official Vatican yearbook, Opus Dei numbers 1,850 priests in the world, along with 83,641 laity, for a total of 85,491 members, representing .008 percent of the global Catholic population of 1.1 billion (55 percent of Opus Dei members, by the way, are women). For a sense of scale, the archdiocese of Hobart on the Australian island of Tasmania contains 87,691 members, meaning that all by itself it’s bigger than Opus Dei worldwide.
Opus Dei, which in Latin means “the Work of God,” is formally clas¬sified as the only “personal prelature” in the Catholic Church, which means that the head of the group in Rome, currently Bishop Javier
Echevarría Rodríguez, has jurisdiction over members for matters that re¬gard the internal life of Opus Dei. For matters concerning all Catholics, members of Opus Dei remain under the jurisdiction of the local bishop. Usually, however, Opus Dei is seen as part of a flowering of lay-led move¬ments and groups in the twentieth century, and it found international fame in the period after the Second Vatican Council.
The core idea of Opus Dei, as presented by Escrivá, is the sanctifica¬tion of ordinary work, meaning that one can find God through the prac¬tice of law, engineering, or medicine, by picking up the garbage or by delivering the mail, if one brings to that work the proper Christian spirit. In order to cultivate such a spirit, Opus Dei members undergo extensive doctrinal and spiritual formation, and generally don’t cut corners in the pursuit of holiness. Most Catholics don’t visit the Blessed Sacrament any¬more? Opus Dei members are required to do so every day. Most Catholics don’t pray the rosary? Again, Opus Dei members do it every day. In Kenya, Archbishop Raphael S. Ndingi of Nairobi jokingly told me that in the old days, if you wanted to identify Opus Dei members in Africa, the thing to do was to give them a ride. If they asked to be let off a mile from their destination so they could say the rosary, they were Opus Dei. Many Catholics today take at least some aspects of Church teaching with a grain of salt, but Opus Dei members are encouraged to “think with the Church,” meaning to accept the entirety of Church teaching on faith and morals. There is a strong emphasis within the clergy of Opus Dei on old-school priestly discipline. They wear clerical dress, pray the breviary, and spend lots of time in the confessional. One sign of their earnestness is that to date, not a single priest of Opus Dei in the United States has been accused of sexual abuse or removed from ministry under the special rules approved in 2002 for the American Church by the Vatican.
It’s not quite right to call this a “traditional” alternative to a more “lib¬eral” postconciliar Catholicism since from a historical point of view Opus Dei is not traditional at all. Its vision of laity and priests, women and men, sharing the same vocation and being part of the same body, all free to pur¬sue that vocation within their professional sphere as they see fit, was so innovative that Escrivá was accused of heresy in 1940s Spain. Inside Opus Dei, most priests have lay spiritual directors, which is a break with traditional clerical culture, and the laity of Opus Dei, both men and women, cast votes for their prelate (meaning the cleric in charge), which is as close to the democratic election of a bishop as one comes in today’s Catholic Church. Opus Dei was the first institution in the Catholic Church to request, and to receive in 1950, Vatican permission to enroll non-Catholics and even non-Christians among its “cooperators,” meaning nonmember supporters.
More broadly, Escrivá’s insistence that the real work of bringing the gospel to the world is to be carried out by laypeople through their secular occupations marks something of a Copernican shift for Catholicism, which has tended to see the laity as a supporting cast in the spiritual drama, with priests and nuns as the lead actors. In a sense, the culture wars of the post-Vatican II period, marked by perennial antagonism be¬tween “left” and “right,” have obscured the original spiritual insights of Opus Dei. What people see is the uncompromising orthodoxy and papal loyalty in which Opus Dei’s message is wrapped, but rarely the message itself.
Despite this, the spirituality and doctrinal convictions of most Opus Dei members do frequently seem “traditional” by contemporary stan¬dards, if only in the sense that they have clung to older prayers, practices, and disciplines in a time when many of those traditions were being un¬derstood in new ways or abandoned. In that sense, Opus Dei is a jolt to a certain kind of Catholic sensibility, to say nothing of a secular outlook that often doesn’t understand institutional religion.
Perhaps because of its “Stout Catholicism” ethos, Opus Dei has be¬come a marker for the broader culture wars in the Church and in the cul¬ture. Self-described Catholic “liberals” typically dislike and oppose Opus Dei. “Conservatives” generally find themselves drawn to its defense, if only because they dislike its critics so intensely. In the broader secular world, Opus Dei has become a shorthand reference for a secretive, closed society with an elitist flavor, a bit like Skull and Bones or the Masons. Thanks to the runaway commercial success of Dan Brown’s novel The Da Vinci Code, these perceptions of Opus Dei have gone mass-market.
Because Opus Dei sets the bar high for its members, the landing can be especially rough when things go wrong. Many ex-members, enough to suggest this is something more than innuendo, report having been hurt by their experiences—they say they were brought to the brink of physical and emotional exhaustion, their contacts with the outside world attenu¬ated, and their approach to both Opus Dei and authority in general steered in the direction of unthinking obedience. As a result, Opus Dei is criticized by a certain percentage of its ex-members with a startling feroc¬ity, some of whom talk about “spiritual abuse” or even violations of their human rights. They claim that the internal climate in Opus Dei—which they describe as defensive, insular, and at times quasi-apocalyptic—can be very different from the image Opus Dei would like to project. In English, the Opus Dei Awareness Network gives voice to these perspec¬tives, as does the www.opuslibros.org Web site in Spanish. These descrip¬tions are contested by tens of thousands of satisfied members as well as ex-members who are still on good terms with Opus Dei. It may be that both groups are describing more or less the same reality, but as seen through different prisms—one convinced that Opus Dei is indeed a “work of God,” the other equally sure that Opus Dei is, to a significant extent, a human instrument of control and power.
Two Distinctions
The mystique and controversy surrounding Opus Dei make careful analy¬sis a complicated task. In sorting through the issues, two distinctions may be helpful. The first is between the message of Opus Dei and the institu¬tion of Opus Dei. Whatever one makes of the fact that a minority of Opus Dei members wear a barbed chain called a “cilice” around their thigh for two hours a day, for example, or that Opus Dei will not publicize the names of its members, these are institutional practices derived from, and therefore secondary to, what Opus Dei is supposed to be all about. Given the attention those practices sometimes draw in the press and on the gos¬sip mill, one can spend a lot of time reading and talking about Opus Dei without ever really touching upon its stated goals and mission.
At its core, the message of Opus Dei is that the redemption of the world will come in large part through laywomen and men sanctifying their daily work, transforming secularity from within. “Spirituality” and “prayer.” according to this way of seeing things, are not things reserved primarily for church, a set of pious practices marked off from the rest of life; the real focus of the spiritual life is one’s ordinary work and relationships, the stuff of daily living that, seen from the point of view of eternity, takes on transcendent significance. It is an explosive concept, with the potential for unleashing creative Christian energy in many areas of endeavor. The ambition is nothing less than reaching across centuries of Church history to revitalize the approach of the earliest Christians—ordinary laywomen and men, indistinguishable from their colleagues and neighbors, going about their normal occupations, who nevertheless “catch fire” with the gospel and change the world.
As legitimate as public curiosity is about the hot-button issues sur¬rounding Opus Dei, such as secrecy, money, and power, phrasing the con¬versation exclusively in these terms risks approaching Opus Dei through a back door, never quite seeing it as it sees itself. For that reason, after two chapters that offer a basic overview of Opus Dei and its founder, sec¬tion 2 of this book (comprising chapters 3 through 6) is devoted to four cornerstones of the spirit of “the Work,” as members refer to the core ideas of Opus Dei: the sanctification of work; being contemplatives in the middle of the world; Christian freedom; and “divine filiation,” meaning a lively appreciation of one’s identity as a son or daughter of God. Section 3 then takes up the most frequent questions about Opus Dei, from the status of women to methods of soliciting new members. Section 2 is therefore primarily about the message of Opus Dei, section 3 about the institution, though these distinctions are not airtight. As in any organiza¬tion, Opus Dei’s aims and aspirations help shape the institutional culture, just as the exigencies of the institution sometimes influence the way those aims are understood and applied.
As another way of expressing this distinction, several former mem¬bers who remain on friendly terms with Opus Dei say their experience taught them that being drawn to the ideals of the group, especially that one’s daily work can be a pathway to holiness, is not the same thing as be¬ing called to membership. One ex-member, who left Opus Dei after more than twenty-five years, put it this way: “It took me a long time to see that understanding and ‘buying into’ Opus Dei’s message does not necessarily constitute a vocation to Opus Dei…. I am in complete agreement with Opus Dei’s message of the universal call to holiness, and of Saint Josemaría’s spirituality of the sanctification of one’s ordinary work and life. That is what attracted me to Opus Dei, and what still does. Yet, while I most definitely feel called to spread this universal call to holiness, I have never felt called to do it specifically `according to the spirit and practice of Opus Dei.’ “
The second distinction is between the sociology of Opus Dei mem¬bers and the philosophy of Opus Dei. That philosophy can he summed up in the word “secularity,” which means, in part, that Opus Dei doesn’t wish to act as an interest group with its own agenda, but to form motivated laity who will draw their own conclusions in the realms of politics, law, fi¬nance, the arts, and so on. There is no Opus Dei “line” on tax policy, or the war on terrorism, or on how health care ought to be delivered, and in fact one will find that the Opus Dei membership holds a wide variety of views on these questions. One sees this in an especially concentrated form in Spain, where it’s not uncommon for politicians who are members of Opus Dei to be subjected to withering attacks in the press by pundits who are also members of Opus Dei.
Today, however, the deepest political fault lines in the West tend to run along cultural issues such as abortion and homosexuality, and the em¬phasis within Opus Dei on “thinking with the Church” places its mem¬bers solidly on the right on those questions—not as members of Opus Dei, but as Catholics who favor a traditional reading of Church doctrine. Inevitably, this means that the kinds of people drawn to Opus Dei, at least in some parts of the world, are more likely to come from conservative cir¬cles, so that many Opus Dei members bring with them conservative atti-tudes on a host of other issues, both on secular politics and on debates inside the Catholic Church. Thus the political and theological tilt inside Opus Dei is clearly to the right, though with exceptions. This has little to do with the philosophy of Opus Dei, however, but rather with the sociol¬ogy of where its “market” is these days.
These sociological tendencies are to some extent the accidents of a particular historical moment. and could change. Opus Dei had a differ¬ent profile in Spain in the 1930s, ‘40s, and ‘50s, when it was regarded as a “liberalizing” force in both secular politics and the Church. As the terms of debate within Catholicism and the broader culture evolve, it’s possible to imagine a future in which Opus Dei’s membership would once again appear less “traditional,” less compactly “conservative.” One of the challenges of this book, therefore, will be to sort out what’s essential about Opus Dei from some of the secondary features that reflect the bag¬gage of a given epoch, either inside the Catholic Church or in the world at large.
Conspiracy Theories
Opus Dei seems to stimulate the most fevered centers of conspiratorial imagination in many people’s brains. Think I’m kidding? As part of the re¬search for this book, I once had a telephone conversation with a critical former member of Opus Dei who was willing to talk about her experi-ences. She opened the conversation, however, by saying she had one question before we began: Was my wife a member of Opus Dei? I laughed out loud, given that my wife is, first of all, Jewish, and a bit ambivalent about Roman Catholicism in general; and second, a convinced leftist hos¬tile to Opus Dei on general principles. Throughout my work on this book she repeatedly struggled with a tension between liking many of the Opus Dei members she met on a personal basis, and yet feeling obligated to op¬pose them. Where in the world, I wanted to know, could someone have gotten the impression that Shannon was a member of “the Work”?
It turns out that my wife had sent out an e-mail some weeks before to a limited group of friends describing some of her recent activities in Rome. One item on the list was that she had attended a small party thrown by a member of Opus Dei for a friend who was returning to the United States. Shannon went because she wanted to say good-bye, not to sign up for the Opus experience. Yet this throwaway reference, which ob¬viously made the rounds in cyberspace, became the basis of a theory that Shannon was in Opus Dei, which by itself would have been enough in some people’s minds to taint the project.
Therefore, let’s get this out of the way: I am not now, nor have I ever been, a member of Opus Dei. No one in my family belongs to Opus Dei. I don’t work for Opus Dei and am not financially or professionally de¬pendent on it. Research for this book, including travel in eight countries (Spain, Italy, Peru, Kenya, Uganda, Russia, the United Kingdom, and the United States), was paid for out of my own pocket. I’m not an enamored member, nor an embittered ex-member. I am a journalist who specializes in the Catholic Church, fascinated with the reports surrounding Opus Dei, and curious to know how much reality stands behind them. In pur¬suit of that aim, I have logged more than three hundred hours of inter¬views, flown tens of thousands of miles, spoken with friends and foes of Opus Dei such as cardinals, archbishops, and bishops along with ordinary faithful, and scoured the literature about Opus Dei in several languages.
I believe I have come as close to understanding Opus Dei as an outsider can, and I hope I can begin to separate fact from fiction with respect to the most common public perceptions.
Though this is not an “authorized” study, the organization granted me privileged insider’s access that no journalist has previously enjoyed. When Doubleday first spoke with me about this project, I approached the peo¬ple at the Rome headquarters of Opus Dei with some trepidation, given their legendary reputation for secrecy. I told them that I was considering writing a book on Opus Dei and wanted to know if they would cooperate. Their immediate response was “yes,” and so I signed the contract and began to work. In the interests of fairness, I have to say that they never faltered in their commitment to full disclosure. I have moved in and out of Opus Dei facilities all over the world, in both men’s and women’s branches. I have been given access to Noticias and Crónica, Spanish-language journals normally reserved only for members. I have been shown private correspondence from the Opus Dei archives that I requested. I lived for five days in an Opus Dei residence in Barcelona, the Colegio Mayor Pedralbes, with the idea of following the official “plan of life” over that time. (Among other things. the experience strengthened my convic¬tion that I am utterly unsuitable for membership in Opus Dei.) All the high-ranking members of Opus Dei inside the Catholic Church gave me interviews, including Cardinals Juan Luis Cipriani and Julián Herranz, Vatican spokesperson Joaquín Navarro-Valls, and the prelate, Bishop Javier Echevarría Rodríguez. The cooperation from Opus Dei was so to¬tal, in fact, that at one point a senior officer in Rome told me that the or¬ganization was performing a “global striptease” on my behalf.
Why would Opus Dei do this? First, my impression is that they are simply much less secretive than is commonly believed. They didn’t have to be convinced of the virtues of cooperation; on the contrary, I found them anxious to tell their story. Second, I believe their calculation was that even an objective hook that gives voice to criticisms of the group would be preferable to the mythology and prejudice that so often clouds public discussion. They were prepared to take their blows, in other words, as long as they’re not below the belt. Whether they’ll still feel that way af-ter reading what follows, of course, remains to be seen.
Several notes of thanks are in order here. First, chapter 10 of this book is heavily dependent upon the work of Joseph Harris, one of the best numbers crunchers in the Catholic Church. I hired Joe to help develop a financial profile of Opus Dei, and he succeeded beyond my wildest dreams. This book for the first time offers a detailed financial profile of Opus Dei in the United States, and a “best guess” estimate of its finan¬cial profile worldwide, largely due to Joe’s efforts. Second, I wish to thank Marc Carroggio of the Opus Dei Information Office in Rome, whose as-sistance in arranging contacts with members of Opus Dei in various parts of the world was invaluable. I also wish to thank Sharon Clasen, an ex-numerary member and a critical voice, who helped me with my re¬search on other ex-members and observers. Dianne and Tammy DiNicola of the Opus Dei Awareness Network were also helpful. Thanks are also due to Tom Roberts, my editor at the National Catholic Reporter, who tol¬erated my frequent absences from Rome and episodic ups-and-downs in my availability to the newspaper in order to allow this project to proceed. All my colleagues at NCR have been helpful in ways beyond my capacity to describe. I also want to extend a word of thanks to the readers of The Word from Rome column, who, knowing of my work on this hook, have sent hundreds of e-mails in the last twelve months sharing their own ex¬periences and perspectives on Opus Dei. While not all of them have found an echo in these pages, they all helped shape my approach, sug¬gested questions, opened new horizons, and were helpful in all manner of unpredictable ways. I want to thank the hundreds of members of Opus Dei around the world, as well as critics and neutral observers, who opened their homes and their lives to me. Talking about one’s spiritual life is never easy in the best of circumstances. and doing so in front of a jour¬nalist holding a mini-disc recorder is perhaps the most trying circum¬stance of all. Yet, realizing the importance of the subject, these people opened up for me and let me in, from a professor of business ethics in Barcelona, Spain, to a Japanese immigrant running a laundry in Lima, to an expert in Pennsylvania on extricating people from cults. I am thankful beyond words for their graciousness, honesty, and courage, regardless of their perspective. Finally, a word of thanks to my long-suffering wife, Shannon, who never really wanted me to do this book and who suffered mightily during its gestation. I know how trying all the travel, extra hours, and endless conversation about Opus Dei was, and somehow I will find a way to make it up to her.
This book is an attempt to tell the truth on a subject where ideology and fantasy often have the upper hand. Ideology, in my view, is the corruption of reason and is morally akin to lying. Rather than taking an ideological approach here, I try to come at the subject from an experient and firsthand point of view. All I can ask is that readers set aside whatever biases they may have with regard to Opus Dei and try to absorb what follows on its own terms. In the end, it is not the aim of this hook to produce an apologia for Opus Dei, nor a polemic against it. It is not up to me to say whether Opus Dei is right or wrong, good or bad, or whether should enjoy its present prominence in Roman Catholicism or not. What I hope to do is provide the tools for readers to reach their own judgment. Despite the polarizing nature of discussion about Opus Dei, I hope we can all agree that a discussion rooted in reality is more likely to be productive.
December 8, 2004
Feast of the Immaculate Conception
sábado, 23 de abril de 2011
El Papa en televisión: una nueva fórmula que vale la pena explorar - La Iglesia en la prensa
El Papa en televisión: una nueva fórmula que vale la pena explorar - La Iglesia en la prensa
Es comprensible el eco que han tenido las preguntas a las que el Papa se ha sometido en el programa de televisión “A sua immagine”, emitido por la RAI y rebotado por otros canales. (Ver aquítranscripción, audio y video). Algunos incluso han comentado que el Papa “da bien” en televisión, casi como si fuera la primera vez que aparece respondiendo a preguntas. Ese tipo de intervenciones capturadas por las cámaras son ya muy numerosas (encuentros con sacerdotes, diálogo con periodistas durante los viajes, diálogos con niños y jóvenes), pero es verdad que se trata de la “primera vez” que un Papa interviene en algo construido expresamente para un programa de televisión.
El gesto de Benedicto XVI es muy coherente con lo que viene haciendo desde el inicio del pontificado y con lo que ya hacía como cardenal. Y es que contrariamente a ciertas caricaturas sobre Benedicto XVI, el Papa no solo aprecia los medios de comunicación, sino que no teme confrontarse a través de ellos con temas complicados. Ya lo había hecho repetidas veces con otras modalidades: ahí están, por ejemplo, sus cuatro libros de entrevistas y sus coloquios públicos –cuando era cardenal- con intelectuales como Jürgen Habermas.
Personalmente, hubiera preferido que el programa de televisión ofreciera solo las preguntas y respuestas del Papa, sin necesidad de glosas ni comentarios por parte de invitados en el estudio (comentarios muy acertados, pero no necesarios: al Papa se le entendía muy bien). Después de esta experiencia vienen ganas de proponer que esta cita se convierta en algo periódico. Pienso que el Papa que responde brevemente y con profundidad a las verdaderas preguntas de la gente es una nueva fórmula que vale explorar. No se trata de hacer comparaciones, pero me parece que su impacto y eficacia sería mucho mayor que el de muchas audiencias.
martes, 28 de diciembre de 2010
Evolving the Scientific Method - THE SCIENTIST
THE SCIENTIST Vol 24 Iss 12 P 30
Date: 2010-12-01
Date: 2010-12-01
Read more: Evolving the Scientific Method - The Scientist - Magazine of the Life Sciences http://www.the-scientist.com/article/display/57831/#ixzz19SpN0sBu
Evidence: A Seductive but Slippery Concept - The Scientist - Magazine of the Life Sciences
This article by Richard Smith goes to the heart of the problem: What is "evidence," and why is it considered "scientific" and definitive? How far can we take our reliance on "science"?
And I add: What about "sciences without (material) evidence"? Why is it considered "unscientific" to accept a truth that does not impact on the senses, and therefore, cannot be "measured"?
Yes, it is "philosophy" and "metaphysics"!
Hope to hear from you!
Wendy
Evidence: A Seductive but Slippery Concept - The Scientist - Magazine of the Life Sciences
Volume 24 | Issue 12 | Page 32
Date: 2010-12-01
Evidence: A Seductive
Medical guidelines based on so-called scientific evidence
And I add: What about "sciences without (material) evidence"? Why is it considered "unscientific" to accept a truth that does not impact on the senses, and therefore, cannot be "measured"?
Yes, it is "philosophy" and "metaphysics"!
Hope to hear from you!
Wendy
Evidence: A Seductive but Slippery Concept - The Scientist - Magazine of the Life Sciences
Volume 24 | Issue 12 | Page 32
Date: 2010-12-01
Evidence: A Seductive
but Slippery Concept
Medical guidelines based on so-called scientific evidence
are not a panacea.
Andrzej Krauze
Much of what we know is wrong—or at least not definitively established to be right. My early years in science and medicine taught me that, so it was with some excitement that I heard the phrase “evidence-based medicine” in the early 1990s. Finally, we would work out what we knew and what we didn’t know.
Soon we had evidence-based everything: medicine, practice, policy, nursing, editing. Marketing departments learned the magic of the phrase, and it appeared four times in the BMJ (which I used to edit) in 1993, 15 in 1994, 285 in 2000, 327 in 2004, and 287 in 2009. Those figures tell a story of explosive expansion, and perhaps of recent decline.
From the beginning there were different schools of evidence-based medicine, reminding me of the feuding schools of psychoanalysis. For some it meant systematic reviews of well-conducted trials. For others it meant systematically searching for all evidence and then combining the evidence that passed a predefined quality hurdle. Quantification was essential for some but unimportant for others, and the importance of “clinical experience” was disputed.
There was also a backlash. Many doctors resented bitterly the implication that medicine had not always been based on evidence, while others saw unworthy people like statisticians and epidemiologists replacing the magnificence of clinicians. Many doctors thought evidence-based medicine a plot driven by insurance companies, politicians, and administrators in order to cut costs.
We must never forget
the complex relationship
between evidence and the truth.
the complex relationship
between evidence and the truth.
The medical establishment, however, soon recognized the need to embrace the term “evidence-based,” and wouldn’t have dreamt of producing a guideline that didn’t feature the two words in its title; various politicians also vowed to make everything evidence-based. Temples devoted to this new form of medicine—like the Cochrane Collaboration and the UK’s National Institute for Health and Clinical Excellence (NICE)—flourished, and the BMJ, I must confess, rode the wave, attracting lots of attention and money.
The discomfort of many clinicians comes from the fact that the data are derived mainly from clinical trials, which exclude the elderly and people with multiple problems. Yet in the “real world” of medicine, particularly general practice, most patients are elderly and most have multiple problems. So can the “evidence” be applied to these patients? Unthinking application of multiple evidence-based guidelines may cause serious problems, says Mike Rawlins, chairman of NICE.
There has always been anxiety that the zealots would insist evidence was all that was needed to make a decision, and in its early days NICE seemed to take this line. Critics quickly pointed out, however, that patients had things called values, as did clinicians, and that clinicians and patients needed to blend their values with the evidence in a way that was often a compromise.
Social scientists have tended to be wary of the reductionist approach of evidence-based medicine and have wanted a much broader range of information to be admissible. Evidence-based medicine has been at its most confident when evaluating drug treatments, but many interventions in health care are far more complex than simply prescribing a drug. Insisting on randomized trials to evaluate these interventions may not only be inappropriate, but also misleading. Interventions may be stamped “ineffective” by the hardliners when they actually might offer substantial benefits. Then there is the constant confusion between “evidence of absence of effectiveness” with “absence of evidence of effectiveness”—two very different things.
Finally, even some of the strongest proponents of evidence-based medicine have become uneasy, as we have increasing evidence that drug companies have managed to manipulate data. In the heartland of evidence-based medicine—drug trials—the “evidence” may be unreliable and misleading.
All this doesn’t mean that evidence-based medicine should be abandoned. It means, rather, that we must never forget the complex relationship between evidence and truth.
Richard Smith is a member of the board of the Public Library of Science and a former editor of the BMJ and chief executive of the BMJ Publishing Group.
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