Briefly Reviewed: January-February 2021

False Positive: A Year of Error, Omission, and Political Correctness in the New England Journal of Medicine

By Theodore Dalrymple

Publisher: Encounter Books

Pages: 248

Price: $25.99

Review Author: Preston R. Simpson

A book about the New England Journal of Medicine might not sound exciting, but Theodore Dalrymple’s False Positive provides informative and entertaining reading for any intelligent layperson interested in how medical decisions are made, how doctors think, and how even prestigious medical journals can sometimes print silly things. Dalrymple is a retired physician who worked for years as a prison doctor in the British National Health Service. Prior to that, he worked widely as a physician in the Third World, and he occasionally sprinkles his commentary with personal anecdotes from his travels.

His father was a Marxist, and Dalrymple is an atheist. Despite that, he comes across as a cultural conservative who stresses the problems that emanate from broken families, who firmly rejects the notion that addicts bear no responsibility for their actions, and who is willing to ridicule notions of multiculturalism. Dalrymple senses that many of the problems in the underclass are, at root, spiritual ones, but the faith that can correct them eludes him. This does not prevent him from observing that recovery from drug abuse sometimes accompanies religious conversion. All in all, his work is insightful and, while the problems he recounts are depressing, his style is entertaining, sometimes hilariously so.

False Positive came about because Dalrymple decided to closely read and analyze a full year (2017) of the New England Journal of Medicine, which, along with the British journal Lancet, is one of the two most prestigious and widely read journals of medicine in the world. Dalrymple reveals two main objectives in writing his book. One is to “alert readers to the sickly self-righteousness that seems to me to have infected the New England Journal of Medicine, contracted no doubt from the wider culture.” He likes to point out the frequent conflation of inequality with inequity (meaning unfairness). Clearly, not everything that is unequal is unfair, but social commentators, including medical ones, seem to forget this. The overrepresentation of blacks making millions in professional sports, for example, is unequal, but no one thinks it unfair. Health inequality can be due to bad genes, bad luck, or personal habits and lifestyle. Dalrymple contends that sociologists often seem overly inclined to attribute inequality to social conditions and look away from individual agency.

Dalrymple’s other objective is “to attune [readers] to the ambiguities of the medical research that is so often taken to provide unequivocal answers, even to questions that are inescapably ethical in nature.” He succeeds on both accounts. Often, however, the articles he cites merely serve as launching pads for him to dilate on important topics in the news as they relate to medicine, such as the ethics of gene therapy, physician-assisted suicide, how journalists interpret medical news, the opioid crisis in the U.S., the legalization of cannabis, and so on.

Dalrymple encounters a couple of recurring problems, including the tendency to equate correlation with causation, and the problems of statistical analysis. He admits that he, like most doctors, does not understand the complex statistical analysis that is a part of so many medical research projects in the modern age. Most likely, even fewer journalists understand them. But, in his words, “common sense is often the first victim of technical sophistication.”

A favorite theme of Dalrymple’s is “the dog that did not bark,” a key clue taken from a Sherlock Holmes story. He cites an article on an outbreak of cholera in Haiti that includes a glancing reference to the fact that cholera was introduced into the country in 2010 but does not say how. Going to other sources, Dalrymple lets us in on the secret that it was introduced by UN peacekeeping forces, and then he speculates as to why this fact was left out.

A teaching case on child abuse mentions an infant left by his mother in the care of her boyfriend while she went to work. Yet this teaching case makes no mention of the epidemiology of child abuse, another dog that fails to bark. Children are far more likely to be abused by their stepfathers and their mothers’ boyfriends than by their own fathers. “And considering that the child was only four months old,” Dalrymple says, “I think it is fair to surmise that the boyfriend who caused the injury would not be the last of the mother’s boyfriends.” But, of course, it would be politically incorrect to criticize her living arrangements. “Anything more explicit [than the oblique reference the teaching case makes to ‘social history’] might bring a blush to the cheeks of those who have suggested for years that it matters not under what dispensation or arrangements parents beget children.” One can almost guarantee that in a case of injury or death by firearm, such authors would mention that a family member kept a gun in the house and failed to lock it properly.

Regarding the ethics and problems of prenatal genetic testing, Dalrymple observes that “in a discussion of decision-making with regard to offspring, there is a conspicuous absence, namely, the figure of the father. Indeed, the very word father does not appear in the article, as if reproduction were by parthenogenesis and no man need be involved.” He continues, “In the authors’ world, then, women not only do but ought to float free in a complete social vacuum (apart from social security). No doubt this is an approximation of how some women live, but the results are happy for no one.” Here the atheist Dalrymple voices social conservatism.

A case of the overdose death of a chronic intravenous drug abuser describes him as on a “pathway to respect.” The sympathetic author refers to the addict’s self-medication as “use” rather than “abuse.” The author also says the addict was incarcerated more than he was free, but he does not say why, “perhaps because the information might have reduced our respect for him,” Dalrymple suggests. He then points out the inconvenient fact that the addict’s incarceration probably prolonged his life. Dalrymple’s experience in Britain, borne out by data, was that addicts were much less likely to die in prison where they got regular meals, free medical care, and an environment free of illegal drugs. The NEJM case implies that the addict took drugs to alleviate his problems: inability to get a job, memories of being locked in a cage, and guilt over the pain he had caused his aged mother. Dalrymple counters, “We are here implicitly being asked to believe that Frankie took heroin to alleviate his problems rather than that his problems were caused by his taking heroin.” He goes on to point out that heroin addiction does not just happen to someone; it requires conscious effort and the overcoming of inhibitions such as injecting oneself with drugs using a needle. The case is an argument for providing facilities where Frankie could inject himself in the presence of professionals. Dalrymple says this might save lives, but is it medical treatment? “Is it very different, morally,” he asks, “from giving habitual robbers large sums of money to desist from their robbery?”

Dalrymple discusses an article on conscience clauses which takes the view that professional societies should decide what is moral, and everyone should then be forced to adhere to that view — and be forced to provide procedures such as abortions or mutilating sex-change operations despite their own moral qualms. Dalrymple has significant reservations. He cites the Nazis, who said they were “only following orders.” This defense was rejected. But now the writers of this NEJM article are proposing to force people to do things they find morally repugnant. Dalrymple sees this as problematic and potentially totalitarian, but he admits he doesn’t have a good solution, thereby exposing the limits of morals untethered from their Christian roots.

That All Shall Be Saved: Heaven, Hell & Universal Salvation

By David Bentley Hart

Publisher: Yale University Press

Pages: 232

Price: $26

Review Author: Jeffrey Wald

David Bentley Hart brings his considerable intellectual resources to the big questions regarding salvation in That All Shall Be Saved: Heaven, Hell & Universal Salvation. In his trademark pugnacious style, Hart argues forcefully in favor of universal salvation (also known as Christian universalism), the belief that through Christ all are saved, from four bases: the nature of God, Scripture, the nature of persons, and human freedom.

Hart argues that belief in eternal damnation is incompatible with belief in the traditional Christian notion of God. He contends that it is not possible (1) that God freely created all things out of nothingness; (2) that God is the Good itself; and (3) that it is certain, or at least possible, that some rational creatures will endure eternal loss of God. For if God created even one soul, knowing him to be destined for eternal misery, then God is either evil or outside the Good itself, and creation would be “something considerably worse than a nightmare.”

Armed with his recently published translation of the New Testament, Hart seeks to show that Scripture is at best equivocal about eternal punishment, and any absolute claim that the New Testament clearly posits the existence of an infinite Hell is based on poor translations of the original Greek. Hart argues that the images of judgment, punishment, and the Last Things in the New Testament are fantastic and fragmentary and can be taken any number of ways. He further argues that 1 Corinthians 15 is perhaps the best and clearest pronouncement of biblical eschatology and supports the belief that all shall be saved: “When all things have been subordinated to him, then will the Son himself also be subordinated to the one who has subordinated all things to him, so that God may be all in all” (v. 28).

Hart believes that, ultimately, Christ did not come simply to offer salvation to individuals. Instead, He came to save the whole human race. Hart writes that “it would be possible for us to be saved as individuals only if it were possible for us to be persons as individuals; and we know we cannot be.” Relying on St. Gregory of Nyssa, Hart contends that the person of Christ offered Himself to the Father for the whole human race, and that that offering is perfected (and the human race perfected) only in the salvation of all. He bluntly states that “there is no way in which persons can be saved as persons except in and with all other persons.”

I admit I find Hart’s thesis and arguments fascinating and am in no position to answer most of them. But as a layman and a Christian, I would like to raise one problem I have with his argument concerning human freedom. Hart contends that “freedom is a being’s power to flourish as what it naturally is,” and in the case of human freedom, to act toward the “transcendent Good toward which rational natures are necessarily oriented.” As God is the Good, the only “purely rational act” is the act conformed to God. Accordingly, “for anyone to be free, there must be real correspondence between his or her mind and the structure of reality, and a rational cognizance on his or her part of what constitutes either the fulfillment or the ruin of a human soul.” No one would thus rationally “choose” Hell, as pure rationality requires conformity with God, and Hell is not in conformity with God. All this leads to Hart’s clincher: “If then there is such a thing as eternal perdition as the result of an eternal refusal of repentance, it must also be the result of an eternal ignorance, and therefore has nothing to do with freedom at all. So, no: Not only is an eternal free rejection of God unlikely; it is a logically vacuous idea.”

For Hart, then, there is only one truly free choice: the choice for eternal salvation. And all persons will ultimately have their reason fully awakened and thereby choose Heaven in an “original and ultimate divine determinism of the creature’s intellect and will.”

Here’s my question: In this telling, what is the role of Christ’s death and Resurrection? If the problem is not fundamentally sin, obstinacy, and a rupture in our relationship with God, but rather infantile rational cognizance, why the Cross? In Hart’s telling, it seems to me, men were never in danger of eternal damnation, for men never could freely choose eternal damnation. All that men need is a little enlightenment, a little more unfettered rationality. But if men do not need rescuing from eternal isolation from God, was the suffering, death, and Resurrection of Jesus just some divine theater performance?

Perhaps these musings are simply the product of an irrational and ignorant mind, and as soon as I am further enlightened I will come to see the abiding veracity of Hart’s claims. In the meantime, I will continue to cling to Jesus and thank Him for His divine rescue, daily trying to choose His Kingdom and His will.

Demonic Foes: My Twenty-Five Years as a Psychiatrist Investigating Possessions, Diabolic Attacks, and the Paranormal

By Richard Gallagher, M.D.

Publisher: HarperOne

Pages: 272

Price: $27.99

Review Author: Michael S. Rose

Three of the most downloaded articles from the NOR website share a common subject. Bobby Jindal’s “Physical Dimensions of Spiritual Warfare” (Dec. 1994), Maria Hsia Chang’s “Perfect Possession” (May 2009), and Richard Gallagher’s “A Case of Demonic Possession” (March 2008) each provide a unique perspective on the problem of evil — and demonic possession in particular. Twelve years after first appearing in these pages, Dr. Gallagher has published an absorbing account of his 25 years’ experience as a medical consultant to exorcist priests. His role: to sort out true cases of demonic possession from the many unfortunate and far more common instances of people who only imagine they are under demonic attack. What makes Demonic Foes at once unique and compelling is that Gallagher, a psychiatrist and a believer in the reality of possession, approaches this often-sensationalized subject by providing scientifically credible evidence to illumine some sobering realities. The facts he provides are straightforward and well documented, drawing on his firsthand experiences with those who have been attacked or possessed by demons.

Early in his career, Gallagher was asked to comment on what are labeled “external oppressions.” He recounts meeting men and women who claimed to have been physically beaten by spirits. Some said they were choked and scratched by unseen assailants, claims supported by photographs and Gallagher’s own observations. Maria, for example, came to him covered in bruises, and Stan presented himself with scratches on his neck and face and produced photographs showing cuts that crisscrossed his legs and torso. It was Gallagher’s job to evaluate whether there might be any diagnosable mental or physical illness to explain the mysterious markings. Part of his discernment process is to rule out emotional trauma, psychosis, and simple lying. In the cases of Maria and Stan, as well as numerous others, all signs pointed to diabolic attacks. Thanks to one exorcist priest, Gallagher learned that genuine attacks don’t just arise out of the blue; some of these victims had naïvely dabbled in occultism earlier in their lives, while others had actively engaged in outright diabolism.

The same can be said for victims of diabolic possession. These cases differ markedly from those of external oppression in that victims are possessed — internally — by a demon who often manifests itself during the victim’s periodic possessed trances. Gallagher explains the classic signs of authentic cases that require exorcism: the victim develops an aversion to religious items, religious talk, and sacramentals. Catherine, for example, would inexplicably go deaf at any mention of God, prayer, or faith. And when these same religious words were written on paper, she became blind to them. Others often lose the ability to enter a church, and most are physically repelled by the celebration of Mass.

Gallagher, of course, has witnessed countless exorcisms conducted by well-trained and faithful Catholic priests. During those sacred rituals, the exorcist would force the demon to reveal itself during the victim’s trance. And, according to prescriptions of the rite, the priest would first ask the demon its name and when it is leaving the possessed victim. These two questions, and their respective answers, are notable because they reveal that demons are personal entities with distinct personalities, intellects, and emotions. These demons speak directly to the exorcists and others in the room. Not only do they curse and spew hate, they often reveal themselves to be belligerent, obstinate, and arrogant — the classic signs of envy.

Skeptics, says Gallagher, will object that there’s nothing particularly extraordinary about what has been summarized to this point. But they are hard-pressed to explain how victims, during exorcism, often exhibit superhuman powers like levitation and impossible bodily contortions, speaking unknown foreign languages, or possessing “hidden” knowledge of people they’d never previously met. Supernormal strength is another classic sign. Gallagher describes, for example, a 95-pound woman who pounced on her exorcist: “She picked him up and threw him half across the room. His body hit the wall, hard.” These preternatural exhibitions are not the products of psychosis; rather, they are precisely what proves that an evil spirit is present and in control. Human beings simply do not have these powers on their own.

In rarer cases, those who personally commit themselves to Satan may be able to demonstrate “special abilities” even outside an overt possessed state. These dedicated diabolists are “able to perform these paranormal feats through no inherent ability of their own but are able to draw upon demonic sources of power in a strange way,” Gallagher explains. Perhaps the most notable case is that of Julia, whom Gallagher describes as the “high priestess” of a Satanic cult. She demonstrated to him that she could not only “wreak havoc” wherever and whenever she wished, but she had what students of the paranormal call “remote viewing”: She could see, through clairvoyance, what others who might be hundreds of miles away can see. On one occasion, after Julia described what “Father A.” was doing and seeing, Gallagher called the priest, who verified every last detail of what Julia saw in her mind’s eye.

Similarly, Gallagher relates the hair-raising story of members of MS-13, the violent street gang responsible for murders, rapes, drug dealing, and child prostitution. Several of them admitted that they had committed themselves to Santa Muerte, an iconic Mexican folk “saint” that occultists appropriate for their diabolic purposes. “Sometimes when we wanted to find out if people were snitching on us,” said one gang member, “we would summon the devil.” For brief periods of time, these gangbangers went into the typical trance state and gained the ability to uncover detailed and previously hidden information about complete strangers — all of which are characteristics of the possessed condition.

One important question Gallagher explores throughout Demonic Foes is fundamental: Why would evil spirits choose to assault and even take over a person’s body? His response is based on his own experience and the collective wisdom of centuries: “Demons are indeed dedicated to destroying human beings — preferably spiritually, but also physically” out of envy and hatred of God. But here again, it is important to note that demonic possession doesn’t just happen to anyone; most victims of possession have at one time or another become willingly involved in the occult.

Demonic Foes serves as a cautionary tale. “Young people who do not have proper direction in spiritual matters,” writes Gallagher, “may turn to playing with witchcraft, casting spells, and the like.” After all, there is a reason the Church forbids consulting psychics and fortunetellers or dabbling in the occult. These are ways that open us to the demonic. Demonic Foes is also a testament to the power of holy water and blessed objects, but even more so the power of the Eucharist and the reality of a spiritual world in general. In the end, Gallagher understands that no amount of evidence will persuade skeptics that possession exists and exorcisms are needed. Far too many people, he laments, are slaves to a materialist worldview that rules out religious questions as unanswerable in nature. Some skeptics, he knows, will never be convinced even if they were to speak directly to the individuals highlighted in his book. “It is too frightening to some people,” he says, “too challenging to others, perhaps too incomprehensible to still others. Many simply prefer not to face these disturbing and, what has by now come to seem to me, obvious realities.”