Testimony of a Jewish Molecular Biologist
The Faith of Biology and the Biology of Faith.
Robert Pollack.
New York: Columbia University Press, 2000. 125 pp.
$19.95 (Hardcover).

During the past century, an increasing number of people, tired of reducing all meaning in the age of science to mere secular ordering, began to look for alternatives.

The first choice led some scientists and humanists to connect science, particularly all that biology represents, to religion. They had to be cautious and tentative, but many were successful. By making this connection, they came closer to the way most people search for meaning beyond the confines of the secular. But the term "religion" could refer to institutions, dogma, and external bearers of tradition without touching the depths.

The second choice, prevalent today, is to connect the search for meaning to spirituality. Settling for it, however, makes things too easy. Spirituality is a convenient, inoffensive, multi-purpose term that has won acceptance because, while it can connote those depths, it can also refer to things as shallow as a tingles-producing warm bath.

The third choice, found in Robert Pollack's new book The Faith of Biology and the Biology of Faith, is used when scientists and religionists alike are ready to take on the tougher issues. Faith, too, can be a term that points to no object—witness Erik Erikson's provocative theses about faith as basic trust. Among the risk takers, however, it can imply an object. In Pollack's case it does. He calls this object of faith's focus by a variety of names, but they come down to God. "In my religion there is a deep and ancient reticence to put a name on what is for us the essence of the unknowable . . . Elohim . . . Jehovah . . . Adonai . . . Lord . . . Ha-Shem, or the Name, is perhaps purest," Pollack writes.

It would be easy to dismiss the connecting implied by the "and" in Pollack's title with a smile or a shrug, were that linkage not being proposed by an evolutionary biologist of note who is sensitive to the difficulties of talking about God in the laboratory or clinic—where the reductionist confinement to the secular ordering of things still prevails.

His sensitivity leads Pollack to a posture in which he does not whine about the fact that people of faith are not often or easily heard. He sets out and with a considerable degree of success is able to get them a hearing.

The same sensitivity and alertness to situation does, however, cause Pollack to be careful, to remind readers that he knows how hard a course he has chosen. He speaks of what he is doing as a departure, as something that the secular-minded might allow at best; he, thus, runs some "risk of alienation" since it is a "project full of paradox." All this before page 19! Will his scientific colleagues stop taking him seriously as a biologist if he is too bold? Will his fellow-believers think he has given too much of faith away in his effort to connect it with biology in complex ways?

Pollack has no difficulty being empathic about the secularist vision: "I acknowledge there is a wholly consistent alternative description of the natural world and our place in it . . . that can lead to exactly the actions I wish to encourage, all without any belief in God." For those who hold this secular viewpoint, "the world has no intrinsic meaning or purpose; we are mortal; we wish it were not so; it is; let's make the best of it by our own human lights; what is wrong with that?"

Pollack's answer: "Nothing is wrong with that position. It used to be my own." But he can no longer honestly hold it. He credits his teacher, Rabbi Adin Steinsaltz, for providing a response to criticism of his book by nonbelieving friends: "If you know someone who says the Throne of God is empty, and lives with that, then you should cling to that person as a good, strong friend. But be careful: almost everyone who says that has already placed something or someone else on that Throne, usually themselves." Pollack is critical of those who place science on that Throne and exempt it from the kind of questioning it merits.

Pollack evidently did not lose status among scientists or administrators at Columbia. While he had wondered whether an "avowedly secular place like Columbia would allow such questions to be asked in the proper spirit of free inquiry," he was to learn, "happily," that the university created and asked him to direct a new interdisciplinary part of the university, the Columbia Center for the Study of Science and Religion (CSSR). The prophet is not without honor in his own country. His kind of testimony and argument is gaining place in our culture, and the CSSR is more evidence of that.

Pollack's preoccupation is with ordering. "Order" shows up in all three chapter headings: Order Versus Meaning; The Meaning Is in the Order; and Meaning Beyond Order. The first deals with science and religion. The second discusses DNA-based medicine in the context of order, while the third concentrates on "The Science of One Life at a Time."

George Santayana contended that, just as we do not talk language but talk a language, so we are not religious but we find a home in a religion; we are not just involved with generic faith but we relate to a faith. Pollack uses his Judaism as an example, but makes no claim that it has to be privileged or monopolistic. This means that people of other faiths can use his case as a model for making analogies. He is a particular being and believer, a self-described Jewish molecular biologist who is aware that one can be Muslim or Christian in other scientific disciplines—though I doubt if he thinks any other is as chancy and provocative as biology of this sort—and can take up science and religion and face up to "Order Versus Meaning" questions in positive ways.

When the two sides of his "versus" in chapter one are posed with equal force, some respondents come back with denial, "there is no meaning to the problem of meaning." Others reject the very possibility that science and religion might inform each other's vision or conception of the world. He chooses the third alternative, acceptance. "Acceptance requires no prior assumptions. Denying nothing of human experience, it accepts the equal validity of feelings and facts," beginning with the facts of evolution in the natural world.

Two features of Pollack's faith, Judaism, that make his approach possible, even credible, have to do both with a legitimate way of speaking of God as Unknowable and with referring to the main relevant feature of human nature as free will and choice. Not all faiths would find the Unknowable a sufficient, to say nothing of satisfying, description. Pollack implicitly leaves to those who hold such faith the search for other descriptions of God and of human features.

Of course, Pollack reminds us, "it is not worth a moment of anyone's time to seek the proof through science of any religious belief." Indeed "the consequences of potential unknowability" include the discouragement of any effort at proof. Instead, he spends time showing the ways in which molecular biological conceptions of the world are themselves signals of a faith commitment, often approaching dogma, something Pollack shuns.

He seeks a level playing field in which two modes of approaching reality can complement each other and provoke interplay. "Whereas many scientists cannot really accept that anyone could believe in a way around mortality, and though many religious persons cannot really believe that any serious person could fail to experience those feelings, some people—I am one of them—choose to carry both sets of thoughts at once."

None of this is easy. Chapter three begins, "it is hard to live in two worlds." Pollack cannot by his own free will choose every day to live according to the laws of his religion; he often chooses reason over irrational obligation and cuts the corners of his religious observance. But he certainly cannot by that same free will restrict his choice to scientific and rational conceptions of the world and human existence.

Some of his reports on his own DNA research concentrate on Jewish cases studies that are condensed in a subtitle of chapter three—Biological Judaism: Bad Science, Bad Religion. Pollack seeks and points to "epiphanous moments" in medical care. "At such a time, and in such places, medicine may give both doctor and patient the chance to share an experience of the Unknowable." He ends with a cautionary, even polemical word: "So long as such times and places are forbidden by the rules of managed care, or by the habits of a science that uses the needs of medicine to pay for its research, medicine will suffer an unnecessary loss of meaning. So long as we passively acquiesce to these constraints, we will all continue to suffer from an avoidable loss of meaning in our own lives."

Some may argue that referring to God as the Unknowable does not do justice to the biblical rootage of Pollack's own Judaism or to the human experience that the good doctor uses as its own kind of evidence, yet he does demonstrate one of the ways historic religious resource can inform searches today.

Others may argue that Pollack's Jewish view of free will is not part of the root of their faith, and may even be challenged by them. Yet wherever people concede that not everything in biology or faith-expression is utterly a matter of destiny, of fate, they will be able to learn from his dramatic resuscitation of that free will concept and find analogies of their own.

Not everything in this terse book is original and not all in it is argument; remember, he is nervous about any claims to "proof." Its proper genre is testimony, in the noblest sense of that term. It is a testimony that helps scientists critique the hegemony of science as the all-inclusive reference to meaning. It offers tentative and modest steps for dealing more positively with the kinds of evidence faith and faiths bring.

Called to Care
Caring Well: Religion, Narrative, and Health Care Ethics.
David H. Smith, editor.
Louisville, Ky.: Westminister John Knox Press, 2000. 276 pp.
$24.95 (Paperback).

This collection of stimulating articles makes a valuable contribution to the resurgence of religious perspectives in medical ethics. As David H. Smith observes in his introduction to the volume, when health policy discussions shun religion for fear of obscurantism or dogmatism, consensus is often purchased at the price of exclusion. Moreover, when religious insights do not play a sufficiently central role in considerations of ethics in clinical care, questions of meaning and purpose with which patients and families struggle are often given short shrift. Caring Well stresses "the importance of disciplined uses of experience in medical settings," in particular, the experiences of healthcare professionals and patients who "articulate their moral concerns and sense of self in traditional religious terms." To "bleach out" religious language and values from what is said here is to fail to care well.

The book opens with a critical appraisal by Richard B. Miller of the "experience-near" methodologies of Paul Ramsey, James Gustafson, and William F. May and ends with a close reading by Gilbert Meilaender of two case stories narrated by Ira Byock in his book Dying Well. Not surprisingly, given the title of the book under review here, several of the authors represented in Caring Well are in dialogue with Byock.

Rounding out Part One is a pair of chapters, one by John D. Barbour on the promise of autobiography for bioethics and one by Paul Lauritzen on the crucial importance to ethics of lived experience—and ways of assessing appeals to experience. Part Two explores the religious dimensions of pediatrics, with chapters by Margaret E. Mohrmann and Louise E. Newman. Part Three focuses on organ donation and transplantation. Allen D. Verhey urges the use of religious ritual as a means of working through the ambiguities of gift relationships and of honoring the dead and their gifts; Ann Mongoven reports and reflects on her interviews with hospital chaplains involved in the process of organ donation. Sharing Part Four with Meilaender are Courtney S. Campbell and David H. Smith. Campbell distinguishes various boundaries he has observed in the provision of hospice care—boundaries of ultimacy, identity, intimacy, and integrity, which can be crossed only with permission and in ways that sustain the boundary breached. Based on his interviews with nurses who care for the dying, Smith observes that the moral practice of nursing entails an expansion of the nurse's identity beyond technical skill and even conventional professional obligations; nursing "calls for a personal relationship with patients."

Of the many merits of this thoughtful and thought-provoking collection, I will single out its attentiveness to various lived experiences of healthcare practice and its intelligent subjection of those experiences to critical theological scrutiny. By "intelligent" I mean to oppose the earlier-mentioned, and not always unwarranted, association of religion with being closed-minded and hidebound. In Caring Well, the reader witnesses committed religious thinkers examining complex experiences and reserving judgment about the truthfulness and usefulness of those experiences until they have been duly explored and tested against the standards set by past and present communities of faith.

For example, take Louise Newman's chapter, "Ethics, Faith, and Healing: Jewish Physicians Reflect on Medical Practice." Newman set out to explore the possibility that remnants of a religious orientation to healing continue to play a role in the scientific practice of pediatric medicine. What she discovered was something inadequately described as a "religious orientation." She discovered a complex web of relations between religious values, experiences, and symbols and such moral virtues of medical practice as compassion, humility, and hope. Moreover, in interpreting the lengthy conversations she had with pediatricians, Newman came to the view that it was not that these caring doctors brought their religion into their practice but that the practice elicited caring from them. Their experiences of power and powerlessness, hope and humility, called them to care.

I could recount multiple examples of this book's chief strength: the authors concentrate on what is happening "on the ground" in healthcare practices and theologically size up those practices. I'll end, instead, with a strong recommendation that you acquire a copy of Caring Well and judge for yourself.

An Encyclopedia of Reform
Clean Living Movements: American Cycles of Health Reform.
Ruth Clifford Engs.
Westport, Conn.: Praeger Publishing, 2000. 312 pp.
$69.50 (Hardcover).

Ruth Clifford Engs describes the myriad of groups and individuals who, throughout American history, hoped to change society by focusing on its health and well-being. She points out three major cycles of health reform, dated 1830–1860, 1890–1920, and 1970–2005. The range of these reforms, as Engs makes clear, is great. From sexual constraint to control of alcohol, drugs, diet, and nicotine, organizations have sought to order perceived chaos and ill health by improving the mental, social, or physical fitness of Americans.

According to the author, each of these cycles is linked to religious reform and perceived social disorder. In her conclusion, Engs writes: "These clean-living cycles surged with or were tangential to religious awakenings. Simultaneously with these awakenings, outgroups such as immigrants and/or youth were seen to exhibit behaviors that contributed to the undermining of society." Certainly this conclusion is worth exploring. While many historians have examined specific reform groups or eras, the notion of comparing the social and economic factors behind the rise and fall of these cycles could be valuable indeed. Numerous questions could be asked about the class, social origins, and ideology of those who created the reforms or filled the ranks of believers. Similarly, the book might have explored the differences and similarities behind the decline of these cycles.

Unfortunately, these questions are not central to the study. In looking at the roots of the reform cycles, the author is content to report that such origins are complex. She then lists secondary sources that have explored the issues in far greater detail. In discussing the crusades of the Jacksonian era, for example, she writes: "Several sociological, economic, and political explanations can be given for the reform enthusiasm of this era, and the reader is encouraged to explore the great body of literature that addresses this period." The focus of the book, then, is clearly not on exploring the roots or decline of the reform cycles, nor is it in examining the links between religious ideology and health reforms. Content to report that these cycles seem to come in eighty-year intervals, the author largely presents an encyclopedia of the reformers and crusades of the defined periods. Founders of organizations are listed with biographical information; movements are narrated in three or four paragraphs. Little is learned of the impact of these crusades or of their social or political context. In the Jacksonian era, for example, short entries describe such reforms as diet, dress, and drink; in the modern period, paragraphs on the Moral Majority and Promise Keepers are followed by discussions on Neo-Paganism and Wicca. Readers are then left to puzzle over who joined these movements, why they attacked specific issues, or what linked them to reforms of an earlier age. All too often, we learn that groups "were formed" or issues "were considered" important, without help in exploring the roots of the movements or social and class origins of their founders.

For those readers, then, who wish to learn the basic biographic information, Clean Living Movements provides a wealth of information. Moreover, the author lists a wide selection of largely secondary literature in the bibliography. Missing, however, is a deep reading into many of the primary works of the time. We rarely hear from the reformers themselves or understand the fears and hopes that motivated their crusades. Nor do we explore the symbolic role of reform as crusaders attempted to restructure society. As a result, the cyclical nature of these reforms appears almost accidental, never firmly linked to economic or structural change.

In the end, we are convinced that these movements were certainly cyclical and extremely widespread. For an explanation of these phenomena, however, we must unfortunately look elsewhere.

The Power of Naming Things Genetic
Sociological Perspectives on the New Genetics (Sociology of Health and Illness).
Peter Conrad and Jonathan Gabe, editors.
Malden, Mass.: Blackwell Publishers, 2000. 232 pp.
$34.95 (Softcover).

The papers collected in this volume first appeared in the September 1999 issue of Sociology of Health and Illness (volume 21, number 5), and it is a delight to have them accessible in this reader-friendly format. Comprising nine articles, this collection examines values in, as well as implications of, the new genetics through the sociological lenses of an international group of scholars most of whom are well known for their thoughtful engagements with these issues.

The papers summarize original empiric work and have been organized into three general themes: the structure and production of genetic knowledge, the social meanings of genetics, and the social impact and implications of genetics. All touch on how, and by whom, knowledge is defined, constructed, and controlled.

Following the editors' unusually informative introductory overview, the first set of papers tackle matters having to do, in general, with who gets to shape how we see gene therapy (author Paul Martin), reproductive genetics (Elizabeth Ettorre), and hereditary breast cancer (Lesley Henderson and Jenny Kitzinger). All three chapters throw new light on the power struggles often associated with naming and managing matters of health and disease. Perhaps the most informative of these is Ettorre's summary of her qualitative study comparing so-called experts' accounts of prenatal genetic screening in four European countries and her careful analysis of the strategies and vocabularies they use to "capture" authority and normalize and routinize these practices.

Each of the three entries in section two, subtitled "The Social Meanings of Genetics," centers its analysis on a specific condition—cystic fibrosis (Alan Stockdale), hereditary breast cancer (Nina Hallowell), and Huntington disease (Susan Cox and William McKellin). Although each spotlighted condition raises issues specific to its diagnostic label, all three papers implicitly address several common themes that reinforce the first section's discussion of power struggles to define risks and responsibilities. Articles by Hallowell and by Cox and McKellin are the strongest, perhaps because of their rich use of qualitative data. By bringing in patients' voices to explain, among other matters, the meanings of risk in the contexts of peoples' lives, these chapters give readers a rich flavor, and not merely a taste, of what having a condition in a family member is like from the inside. Stockwell's analysis of the development of gene therapies for cystic fibrosis is fine, but it does not go far enough in exploring the impact of commercial support on such things as patients' support groups in the push for high-tech interventions.

The triad of chapters in the final section is a heterogeneous mix that examines: (a) how clinical and molecular geneticists actually write about what they do, thereby setting up boundaries between science and society (Sarah Cunningham-Burley and Anne Kerr); (b) how "disability" discourse is shaped by activists v. medical specialists (Tom Shakespeare); and (c) how the control, surveillance, and identification of individuals has come to rely on DNA patterns (Dorothy Nelkin and Lori Andrews). These chapters not only question the process by which things are called "genetic"—who gets to do the calling and what is then done—they also clarify why this process should matter to all of us.

This book is not a seamless whole; nevertheless, the chapters build on, rather than repeat, each other, with the recurrent themes lending continuity and providing compelling evidence that the power to name is a mighty one—genetic naming is too important to be left for any self-proclaimed experts alone. The collection as a whole makes it clear that citizens—to whom interventions will be offered, on whom they will be practiced, and from whose basic health problems and health needs the new genetics may deflect attention and resources—must be involved in these discussions. The material here will nourish this involvement. Written with a minimum of jargon, the book should attract a general audience beyond sociologists or other social scientists. Although the majority of the authors are based in the United Kingdom, the critiques do not have geographic boundaries and will apply wherever new genetics is found.

This book is an excellent place to start for those who want to go beyond superficial discussions of how to manage the implications of things genetic to understand the multiple meanings of "genetics" as ways of seeing and of doing, to unpack the values in using "genetics" as an adjective. One hopes that those practicing genetics will also read and learn from this material. Some self-reflection never hurts.

Renewing the Covenant
The Physician's Covenant: Images of the Healer in Medical Ethics.
William F. May.
2nd edition. Louisville, Ky.: Westminster John Knox Press, 2000. 249 pp.
$19.95 (Softcover).

I read the first edition of The Physician's Covenant in 1991, just as I was about to start my first faculty position. At the time this book was eight years old, already a classic, and on my list of must-reads. Now, seventeen years after its original publication, a second edition has appeared. It is well worth republishing.

This book does not solve any ethical dilemmas. While he has an uncanny understanding of the world that physicians, nurses, and other healthcare professionals inhabit, May discusses few cases. Rather, he describes the moral milieu in which cases are encountered and resolved—the presuppositions, the language, the metaphors, the hierarchy, and the expectations of American healthcare professionals and patients. In some ways, he describes the socio-philosophical underpinnings of medical morality in the way that Thomas Kuhn analyzed science in The Structure of Scientific Revolutions. May's overarching argument is that ethics must critique the underpinnings of medical morality every bit as much as it must help to resolve particular dilemmas.

May is both a thoughtful and a graceful writer. He draws heavily on literary sources to illustrate his points. He quotes Dostoevsky, Faulkner, Kipling, Hemingway, and Tolstoy at length. The link he forges between literature and medicine is metaphor. The metaphors of the physician as parent, fighter, technician, and teacher form the backbone of the book. He shows the persistence of these metaphors in all aspects of medicine, and gives each its due. But he makes a persuasive case that the patient and physician must fundamentally view their relationship as a covenant. Given all that has happened in medicine since the first edition, it is even more necessary today to articulate this covenantal relationship than it was seventeen years ago.

While his writing is accessible to all readers, May is not afraid to write as a Christian. For instance, I found his exegesis of the story of Jesus healing the lame man at the pool of Bethesda (John 5:1–15) powerful. He points out that Jesus acted for justice. To be healed by its waters, one needed to be the first in the pool. But this man could never get to the pool before others did. He was therefore excluded from the healing pool—the way 43 million uninsured Americans are now similarly excluded. The Gospel mandate is to be sure that none are excluded.

There are three genuinely new aspects to this edition. First, in the introduction, he addresses the new interest in spirituality and medicine. Second, he has added a chapter on healthcare reform entitled "Covenanted Health Care Systems." Third, he has updated previous chapters by adding new material on genetic engineering and by further refining his position on physician-assisted suicide. The sections on healthcare reform and physician-assisted suicide come almost word for word from his 1996 book, Testing the Medical Covenant, but they make sense in the context of the second edition of this earlier work.

The chapter "Covenanted Institutions" could have been updated more substantially. On the one hand, it is an almost masterful exposition of all the presuppositions, role dynamics, and tensions that form the context for what has come to be known as institutional ethics. On the other hand, it suffers because it refers to health maintenance organizations (HMOs) only in the context of the old staff-model HMO, for which Kaiser remains the prototype. Unfortunately, staff-model HMOs represent only a tiny fraction of the complex, convoluted, and much more morally complicated conglomerates of HMOs and preferred provider organizations that constitute contemporary managed care. This makes the chapter seem outdated, and therefore risks obscuring its still very current insights.

Another minor complaint is that the index is very sparse. This is a missed opportunity for the second edition of a book that is already a classic in this relatively young field—a book that will be read by scholars, students, and interested medical laity for years to come.

But these minor criticisms should not deter any reader. Those who read the first edition will enjoy returning to this gentle spring of wisdom. Those who have never read it now have a chance to drink deeply.