Evidence-Based Medicine, Evidence-Based Religion

The Church of Jesus Christ of Latter-day Saints is an evidence-based religion

by Alan B. Sanderson, MD

evidence-based religionGeorge Washington died in 1799 of an upper respiratory infection, which he most probably would have survived if not for three doctors sending him into hypovolemic shock by draining out half of his blood volume. “Therapeutic” bloodletting was a staple procedure in western medicine at the time, and the practice can be traced back to at least the 5th century BC. Classical Greek medical practitioners, including Hippocrates and his colleagues, reasoned that removing excess blood from the body was a way of balancing the four humors. They even pointed to the female menstrual cycle as a natural example of how the body tries to maintain this balance. This reasoning was more philosophical than scientific, but at the time it seemed reasonable and even plausible. Washington himself was a firm believer in the practice (until it killed him).

Modern people tend to be shocked at the manifest ignorance of bloodletting because we know more about the physiology of the human body than they did back then. At the time this practice became entrenched in western medicine people didn’t understand that blood circulated through the body, and were unaware that arteries connected to veins via capillaries. They thought that blood was produced in various organs and then consumed in others. As medicine gradually began to understand and use the tools of experimental science through the 19th and 20th centuries, and as evidence mounted that bloodletting actually harms patients, the practice was gradually extinguished in western medicine. (Although there are a few rare diseases like hemochromatosis where therapeutic phlebotomy is still employed, and bloodletting is still used in some alternative medicine systems.) Continue reading

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The Whole Personal Protective Equipment of God

Judgment, humility, righteousness, virtue, praise — I will think about all of these things when I put on my PPE. The next time you are in a hospital or clinic, maybe you will too.

by Alan B. Sanderson, MD


All dressed up and ready to see a patient on contact isolation. The patient we were about to see had head lice, if I remember right.

The hospital where I trained had a few specialized rooms designed for patients who have tuberculosis, with special ventilation systems to produce negative airflow into the room so that the patient’s germs wouldn’t spread down the hall and through the hospital, infecting other patients. I spent a total of three months on the infectious diseases specialty services during medical school and internship, and during those months I spent a lot of time seeing patients in those negative airflow rooms. Outside the room we had to dress up in a mask, gown, and gloves, and during one of those ritual dressings the attending physician on our team turned to the rest of us and asked, “Has your PPD turned positive yet?” The rest of us on the team stared at him in muted alarm, pondering the implications of what he had just said. The PPD (purified protein derivative) test is used as a screening instrument for tuberculosis, which is an infection I hope I never get. “I remember when mine went positive,” he continued. “It was during my fellowship. I had to take isoniazid for 9 months.” I placed my face mask on very carefully that day, and have ever since. Coming to understand the real purpose for something forever changes your attitude about it, as mine did that day. Continue reading

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Grandma’s Hands: The Story of a Frontier Midwife

Grandma’s hands show us our potential to become better than we are, and give us inspiration to rise to that potential.

by Alan Sanderson, MD

This week we celebrate Pioneer Day in Utah, commemorating the entry of the first wagon train of pioneers into the Salt Lake Valley. On 24 July 1847, Brigham Young looked over the valley for the first time and declared, “This is the right place.” Each year on this day Latter-day Saints around the world remember and celebrate the sturdy and heroic generations of the nineteenth century pioneer era of Church history. We have much to learn from these pioneers, who worked so hard and sacrificed so much to build the communities of the Mountain West. All of my family lines were in the Utah Territory in the 1800’s, and I love to tell my kids the stories of our pioneer ancestors. Five of my children have names drawn from these family members and their stories.

Lucinda Stewart Brown

Lucinda Araminta Stewart (1865-1941)

In discussing the Utah pioneers there is a tendency to grant them a sort of nobility status, which I think is understandable and defensible considering the endurance of their accomplishments. But it should be made clear that whatever titles of nobility they may deserve are strictly not hereditary, and must be individually re-earned by each generation. In other words, I am not a great man because of who my ancestors were, but I may prove myself to be a great man by my own character and by my own contributions to the betterment of society. Also, each generation’s nobility is available by the same means to everyone in that generation, regardless of who they descend from.

Lately I have been thinking about my great-great grandmother, Lucinda Araminta Stewart (1865-1941), who was known to her friends as “Luna.” I feel a kinship with her because she was also a healthcare professional, although her life was dramatically different from mine. Her story is a tragedy and a triumph, almost like a phoenix rising from the ashes, except that she could never seem to rise very far above them.

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What is Pain?

The emotion of guilt is very similar to the sensation of physical pain, and serves a similar purpose.

by Alan B. Sanderson, MD

Pain is a subject that pretty much everyone has some experience with. We have been experiencing pain since before our earliest memories. It is also a subject familiar to medical doctors, most of whom spend a significant portion of their time trying to manage pain in their patients. The current epidemic of opioid addiction is a tragedy for many people and their loved ones, and a hardship for countless more. This post will begin by discussing physical pain, and then move into a discussion about the analogous subject of emotional guilt.

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Where is the Office for EGO Processing?

A humble doctor can be just as capable and skilled as a proud doctor, and can have just as much confidence in his own ability, but his meekness makes him able to accept correction and acknowledge his own mistakes, and gives him a greater advantage in leading his team.

by Alan Sanderson

ID Processing

Some years ago as I walked the halls of the massive sprawling medical campus where I did my residency training, I came upon a sign that caught my attention because of its potential double meaning. The sign said, “ID Processing,” which is the office where ID badges are made. But I thought to myself, “Where’s the office for EGO Processing? That’s what we really need around here.”

(If you don’t get the joke, then look up Sigmund Freud’s structural model of the psyche. I remember my parents told me when I was a kid that if you have to explain a joke, then it wasn’t funny.)

Anyone familiar with healthcare team dynamics will know that the doctor is the most likely person on the team to have a big ego. This seems to be particularly true for surgeons and other proceduralists, but I have met doctors from many specialties who seem to have an inflated view of themselves. (For the record, I have also known many surgeons who are kind and humble people.)

There are many reasons for doctors to have inflated egos, and much has been written on the subject. The proposed causes include baseline personality characteristics, the conditioning of medical training, and the lack of effective leadership skills training. Also, having a specialized knowledge base and skill set changes the way people treat you and the way you think about yourself, especially when that skill set is in high demand.

But there is a difference between having confidence in yourself and in your skills (which is generally a good thing), and having an inflated ego (which is considered to be a bad thing). Is the difference simply a matter of degree, or is there some qualitative difference? And what is actually bad about having a big ego?

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Going Off Course

We don’t want to reach the finish line and then discover that we have skipped part of the trail.

by Alan B. Sanderson, MD

Recently I ran a trail half marathon near Bryce Canyon, and I have been thinking about an incident during the race ever since. At about mile 7.5 I was coming down a dirt road at a fast pace, with tall pine trees all around and hoodoos in the cliffs above me to my right. At a small clearing in the woods the course suddenly veered off of the road in a sharp angle onto a single-track side trail to the right. The turn was marked with signs and pink ribbons tied to a tree branch at the turn. I was watching for this turnoff because I had run on these trails before and I had studied the course before race day.

Going Off Course - map-arrows

Satellite view of the tight turn onto the side trail to the right. The dashed path shows where the runner went off course.

But a runner who was a few hundred feet in front of me blew right past the signs and kept running down the road. This surprised and confused me, and I didn’t know how to react in the moment. My first thought was actually, “Oh, maybe she’s not running in the race after all.” I like to go trail running by myself, and occasionally I will happen upon a trail race which is underway. (That actually happened to me just two weeks before the race.) Also there were multiple race distances on the same day, with runners doing 50 kilometers, 50 miles, and 100 miles on overlapping courses. Maybe she was racing one of the other distances?

A few minutes after turning up the side trail it finally occurred to me that I should have asked her. I should have called out, “Hey! You’re going off course!” or “You missed the turn!” But she looked so confident, running right past the signs, that I didn’t even think to question her at first. Obviously she knew where she was going.

Or maybe not.
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Simultaneously on Both Sides of the Veil

I wrote a guest blog post at my brother’s website, which went live this morning. It is a discussion of the use of chiasmus in Elder Dale G. Renlund’s April 2018 General Conference talk. Elder Renlund told a remarkable story about a heart transplant recipient who became an important figure in the life of his donor’s family. The recipient acted as proxy for his donor as he was sealed to his family in the temple. It is a powerful story, and Elder Renlund used a subtle but very effective literary device to tell it, as I explain in the post: Simultaneously on Both Sides of the Veil: Chiasmus in Elder Renlund’s “Family History and Temple Work: Sealing and Healing.”


Alan B. Sanderson, MD is a member of The Church of Jesus Christ of Latter-day Saints and is a practicing neurologist.

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