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Monday, April 13, 2009

Leviticus and clinical guidelines

I just had another birthday, and, with my daughter's Bat Mitzvah coming up, my own Bar Mitzvah, 39 years ago, came to mind. (A Bar Mitzvah is a religious ceremony when a Jewish 13-year-old formally takes on the obligations of adulthood, in front of friends and family.)

My Torah (Old Testament) portion was in Chapter 13 of Leviticus, where God gives instructions to the priests – the closest thing then to doctors – on how to diagnose various skin conditions. Various types of skin blemishes and conditions are described and differentiated, to allow differential diagnoses, with different treatments prescribed for each.

In three key ways, this method is superior to that often used by today's doctors. First, the guidelines in Leviticus are clearly authoritative. The source has credibility among the priestly medical practitioners of that time and place, e.g., with reference to the proper sterilization of cloths. God clearly specified that under certain circumstances the double washing of certain cloths can make them clean enough for re-use (verse 58). Hospitals might find their policies on sterilization and the prevention of infections are somewhat less clear, and are less authoritative, than this, as the embarrassing news about the recent spate of hospital acquired infections makes clear.

Second, the guidelines in Leviticus were widely known. They had been published in numerous languages, and the Bible is the most widely owned book, so everyone could refer to them if needed. By contrast, often today's doctors aren’t aware of consensus guidelines, and don't heed them.

Third, the guidelines in Leviticus have been translated into a language that consumers can readily understand. Note that they originally appeared in a language – Aramaic - readable only by a few. This may be the biggest advantage that Leviticus holds over modern clinical guidelines, which are generally known only to doctors. Only now, with the Internet, is diagnostic information readily widely available to laymen.

The clinical guidelines in Leviticus are authoritative, widely known and available, and clearly understandable by laymen – excellent goals for more modern clinical guidelines in our more skeptical era.

Read a story about modern diagnosis in the Internet era.

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