26 Jan BESHALACH-CORONA DIARY #21: RELIANCE UPON HUMAN MEDICINE
As the ferocious waves of the Red Sea parted, the marine floor was paved dry to welcome the passage of the Jews. Suddenly, the raging waters tumbled down upon the Egyptian soldiers as their powerful chariots were mercilessly tossed like matchsticks. Inspired by their rescue by the G-d of their Fathers, the entire Jewish nation erupted in song and poetic chant.
After calm was restored, G-d reminded the nation that if they continued to follow His will and adhere to His commandments, He would continue to protect them; G-d promised that “all the sickness administered to Egypt will not affect you because I will be your healer”. It is striking that G-d presents himself as national Healer not as a Creator or a Redeemer. This image of “G-d as Healer” resonated deeply with a nation no doubt traumatized by the terrible diseases they observed in Egypt. Many of the ten plagues directly blighted the Egyptians with disease: “dever” unleashed a pandemic which annihilated the cattle and threatened to spread to humans. Shechin- a contagious epidemiological disease forced widespread quarantine and ultimately, on the night of our liberation, an invisible wave of death visited every Egyptian household. In addition to those plagues, other makkot “indirectly” led to failing health conditions: the combination of “dam” and tzefardei’a reduced the great Nile river – previously a source of food and life- into a rotting cesspool of dead fish and putrefying corpses of frogs. Amidst a kinim invasion of rats, bugs and rodents followed by an incursion of wild beasts, Egyptian health and hygiene quickly deteriorated. Having witnessed the collapse of a once mighty Egypt into an ailing and sickly country, the Jews were thrilled to hear that G-d would be their Healer.
This guarantee – that G-d is our Healer- raises an interesting question: If G-d promises to be our Healer, is it appropriate to solicit treatment from human healers and is it religiously justifiable to practice scientific medicine? If G-d promises healing as a reward for virtuous lifestyles, shouldn’t illness be interpreted solely as punishment for religious underperformance? When facing these medical punishments for our failed religious behavior, shouldn’t our primary response be religious improvement so that G-d fulfills His promise to heal us? Does reliance upon doctors indicate a lack of faith that G-d will heal us?
The Rambam, himself the official doctor of the Sultan Saladin of Egypt, certainly believed that rational and scientific medicine were legitimate recourses in the face of illness. Staunchly upholding the value of rational medicine, he strongly derided the claim that reliance upon human medical intervention reflects diminished faith. Of course, he also authored at least ten medical works. Yet the Ramban – Nachmanides- strongly disagreed, claiming that, in a perfect order, a person of superior spiritual caliber should rely solely upon G-d and not seek any medical intervention. Afflicted by illness, a patient should primarily inspect their religious behavior, repent their sins, and pray for Divine healing. Accentuating this ideal, the Rambam exclaims “A doctor has no function in the house of a pious man”. Sadly, very few of us, if any, can sustain the level of religious lifestyle which would elicit or “deserve” supernatural healing from G-d, and we must all rely upon rational medicine while we pray to G-d for His healing. However, fundamentally, human health is predicated solely upon G-d’s will and, ideally, human medical practice is both unnecessary and reflective of deficient faith.
The overall Jewish tradition has certainly favored the approach of the Rambam, and Jews have typically relied upon human medical intervention. Essentially, Judaism, debunks the ancient belief that illness is based on magical possession by demons or other supernatural forces, and can only be eliminated through supernatural means. The Torah itself provides rational medical-based guidelines: disease-prevention is already apparent in the treatment of a metzora and of other potentially contagious people; the laws of mikvah and of washing hands before consuming food maintains healthy hygiene. Likewise, comprehensive lists of medicinal treatments in the Talmud reinforce how attentive Chazal were to medical treatments of the day.
Historically, rational medicine traces itself back to the 5th century BCE to the Greek doctor Hippocrates. Since then Jews have generally been at the forefront both of the development of the science of medicine as well as in the provision of medical care. Throughout much of the Middle ages many medical books were actually written in Hebrew as Jews were often the personal doctors of kings and noblemen.
A modern catalyst for Jewish entry into the medical profession was, ironically, the barring of Jews from careers in law, finance and government. Instead, many Jews entered the more egalitarian medical profession which allowed a private person to “hang his own shingle” and earn a respectable if not wealthy living. Furthermore, Jews gravitated to the medical profession as a “Divine mandate” to heal the world and to shape it in the image of a kind and compassionate G-d; if G-d is merciful, He doesn’t desire human suffering and those who relieve human suffering are performing G-d’s work. For the past 2500 years Jews have participated enthusiastically in the march of medical science and the delivery of medical treatment.
The Covid-19 crisis has altered our perspective on much of our world and, in particular, has highlighted the limits of modern medicine. Our struggle to contain this viral infection has reminded us that, despite the dramatic advances of medicine over the past 400 years, humans remain vulnerable and reliant upon Divine healing. There is sad irony in the toll of Covid-19 upon the elderly generation. Prior to this pandemic, modern medicine had radically extended human life expectancy. In the hundred years leading to 2018, life expectancy had jumped by over 20 years! Ironically and sadly, so many of the elderly whose lives were extended by modern medicine were most susceptible to the ravages of Covid-19. Valiantly, our society has rallied and adopted drastic measures to protect the lives of this older generation, but, sadly, our efforts have fallen short.
The Covid-19 crisis has also reminded us of the limits of human medicine on a different plane. As humanity has urbanized and populations have become concentrated in large centers, humanity is forced to deal with an entirely new and different challenge- public health management. It is one thing to heal individuals and quite another to plan medical policies for large populations. Large populations demand public health management – policies to determine the allocation of public resources such as money, hospital beds, personnel, medical devices and medicines. Despite our best efforts to plan these policies based on statistical likelihoods, the pandemic has toppled all our predictions and wrought havoc with our health care “systems”.
The challenge of public health is just beginning; at this stage most countries are dealing with the double challenge of containing infection while rolling out vaccines. Vaccine distribution is also a public health challenge and countries which enjoy more organized public health systems are far better equipped to vaccinate efficiently and speedily.
Ideally, even though we participate in human medical treatment we should look to G-d as our Healer. Humanity equipped itself with extraordinary medical prowess, but may have forgotten the Divine role in the process of human health. Covid-19 has reminded us that both on a personal level as well as in public health management human efforts will always be partial and only a Divine Healer can provide our full medical coverage.