Aug 06 2007

It’s A Miracle

I admit I am always bugged when I hear a news report to the effect that, “Doctors say the patient’s recovery is nothing short of miraculous.” I don’t know if more commonly reporters are introducing the term “miracle,” if they are suckering the doctors they are interviewing into using or endorsing it, or if the doctors are using the term on their own. Either way, it inaccurate and fosters misunderstanding and superstition.

Just today I received the following question from a long time NESS member, Fred Cunningham:

“The other day someone stated in letter to some publication that one proof of God was the 65 miracles at Lourdes. I have heard of medical miracles such as spontaneous remission of advanced cancer, etc. Has anyone compared the probability of a miracle at Lourdes with the natural rate of such events. I doubt that it would be higher than the natural rate and suspect that it is lower. An awful lot of people go to the place so only 65 cures seems a pretty poor result. The term ‘medical miracle’ may be a bit fuzzy, but there must be some standard set by Lourdes that can be used elsewhere. Have you ever encountered a situation that might be considered a miracle? At the college I went to, the term ‘miracle’ was defined as an event that had probability of less than one in a thousand.”

The term “miracle” implies a supernatural event, one that cannot be explained scientifically or naturalistically. It also carries a definite religious connotation, more so than “supernatural” or “paranormal.” Sometimes the term is used to refer to a low probability event. This is an unfortunate alternate definition, and I discourage its use, because it carries the implication that low probability events are inherently difficult or impossible to explain and therefore may be, or are likely to be, supernatural.

This is, of course, untrue. Low probability events should happen all the time, given the high number of opportunities for such events to occur. Let’s take the example of spontaneous remission of cancers. This is known to happen, even if it is rare – estimated at about 1/100,000 cases. But out of 1 million cancer patients, 10 will have a spontaneous remission by chance alone. Those 10 patients will have a dramatic story to tell – and for each of them the remission was a low probability event.

This is just an application of the law of big numbers – with enough people, low probability events should happen often. In a city of 10 million people, one in a million events should happen 10 times a day. Applying the word “miracle” to such events obscures their true nature and implies something unnecessary – an outside supernatural agent.

Believers at this point might argue – “Well, how do you know they are not miracles?” You don’t, and you can’t. At best we might have an unexplained phenomenon, but unexplained does not mean unexplainable, and it does not mean miracle. We cannot know what we don’t know, and so the finite nature of our knowledge means we can never conclude that an event was a true miracle. Further, the term does not carry the connotation – currently unexplained by science, but rather the implication that a supernatural agent was necessary.

So from a logical point of view the concept of miracle is very problematic, and is often just used to falsely imply that a low probability event requires some special explanation.

Specifically with regard to unexplained medical recoveries, there are actually a number of plausible explanations for such cases. I am not aware of any case that is adequately documented and for which there is no possible prosaic explanation. There are a number of standard explanations that would need to be excluded before concluding that a case was unexplained (let alone leaping to the “miracle” option).

False diagnosis

Diagnostic errors are made in medicine all the time. Even with our advanced diagnostic tools and long experience, the human body is complex and highly variable. Medicine is cognitively a very difficult profession, and doctors make mistakes or have holes in their knowledge or experience. Also, often our diagnoses are based upon probability and sometime patients have a very low probability medical situation.

It is therefore possible for patients to be given an incurable, even fatal, diagnosis that is in error. When they then fail to progress or die they may conclude that they have been miraculously delivered from their illness, when in fact they never had it in the first place.

The situation is worsened by charlatans, faith healers, and other practitioners who make false diagnoses as a matter of course. It turns out it is really easy to cure someone of a disease they never had in the first place. So it is easy to make a career out of giving people a fake diagnosis for their symptoms, then giving them a fake treatment for their fake diagnosis and proclaiming them cured.

Spontaneous remission

As stated above, sometimes diseases get better on their own. Most of the ills that plague people are self-limiting. They will get better on their own eventually. Even serious diseases, like cancer, may spontaneously remit. Sometimes the immune system wins the fight against cancer, or there is some other biological factor at work.

Wishful thinking

Often cures are declared in the absence of any real objective evidence. I have seen this personally countless times. For example, I had a patient with advanced Parkinson’s disease who went to Mexico to get embryonic tissue injected into his gluteus maximus. The treatment had no chance of working, and who knows what the poor guy was actually injected with. I saw him several years later and he was convinced that the treatment worked, despite the fact that objectively he had end-stage Parkinson’s disease.

There is a host of psychological factors at work, not just wishful thinking. There is also the need to justify expense or sacrifice, unwillingness to admit being duped, and the good old-fashioned placebo effect. The bottom line is that it is very easy for people to be absolutely convinced that they are better when they are not, that they were helped when they weren’t. It’s just the way our brains work.

Fraud

Sometimes people lie. Sometimes this is justified by pious ends – so called pious fraud. For example, someone might believe that if they just convinced the world that Lourdes was truly a miraculous place, more people would visit and be helped by it.

Multiple causes

It is very common for people to seek out multiple treatments for a desperate disease. They may take chemotherapy for their cancer, and take snake oil, and go to a faith healer. If they have a better than expected recovery, guess who gets the credit? Further, as the story gets passed around the details alter to make it more inspirational. Eventually the story is told as – I got cancer, the doctors said there was nothing they could do, they left me to die, I went to this faith healer, and now I am cured. Some of the details, like chemo and radiation, may have been left out.

Dead Men Tell No Tales

There is also a huge reporting bias at work. People who feel, for whatever reason, that they had a miraculous recovery will scream about it from the roof tops. Those who tried an alternative treatment or faith healer and got no results are more likely just to keep quiet about it. They may in fact be embarrassed that they tried something so desperate.

Also, once people die of their disease they are no longer around to tell their tale. It is typical for cancer patients, once diagnosed, to go through a series of treatments. This may include faith healing or alternative treatments. Then they are told they are cured, and they go around telling people they are cured. There is often this honeymoon period, especially if there was surgery and chemo to reduce a tumor, where there may be no outward evidence that the cancer was never completely gone. Once the cancer comes back, the person is no longer touted as a miracle cure and they are left to quietly die. Of course there are exceptions to this, but this is a typical scenario that hugely biases reporting of cases toward apparent cures.

The only way to know if there is a real treatment effect is to carefully count all the cases, including those who die.

Once all of these factors are taken into consideration, there are no documented medical cases of spontaneous cures that defy plausible medical explanation. Certainly there is nothing that can be touted as evidence for the miraculous.

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