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20 Make believe and medicine: lessons from the four holy gospels
  1. Jean Doubovetzky
  1. Laboratòri Albigès de pensada laterala, Albi, France. Prescrire, Paris, France


Fighting overdiagnosis and overtreatment is difficult, because these concepts are difficult to master and to explain, and because professionals and people are eager to believe in healing.

‘Make believe’ is powerful and this is why it is important to take lessons from the best makers of beliefs, whether we have or not religious feelings.

In the French or English translations of the Holy Gospels, Jesus’ healings are depicted in a way that ‘make believe’ supernatural miracles. How does this happen? History, linguistics, archaeology, exegesis and medicine combine to help us understand what may have really happened, and provide lessons for contemporary contexts.

Shift in the meaning of the words Let’s talk about the blind man. In Aramaic language, there is no word meaning ‘not being able to perceive things with the eyes’, implying the idea of a definitive state. The only existing word means ‘any serious impairment of sight’, even of short duration. Jesus’ treatment is precisely described: saliva, a plaster of clay and washings with clear water. At that time, all around the Mediterranean Sea, this happens to have been the standard care for purulent conjunctivitis. In the same way, deafness referred to impaired hearing, but may have been a simple cerumen cap. ‘Lepers’ only suffered from skin diseases that made them ‘unclean’ for the Torah, possibly eczema or psoriasis.

In modern times, we see the same phenomena when mere risk factors are widely considered as serious illnesses, and when the media say that mammography screening lower ‘mortality’ instead of ‘breast cancer mortality’, making the benefit absolute.

Shrinking time Most Jesus’ healing stories give a sensation of immediateness: healing seems to happen in a few minutes. There are strong reasons to believe that quite often, it took several days or weeks to complete. For instance, when the ten lepers go to see the priests in Jerusalem to be declared ‘clean again’, from the border between Galilea and Samaria, it must have taken 5 to 12 days. But when you read the story, you think it only took a few hours. When expressing benefits and harms from cardiovascular or cancer prevention, time scale should always be stated.

Forgetting natural history of disease When he sees the so-called lepers, Jesus only tell them that they are ‘clean’. He doesn’t heal them. When he sees Jairus’ daughter, he says ‘She is not dead but asleep’. He corrects a false diagnosis of death, he does not resurrect her.

The same mental misperceptions are at play when breast cancer ‘survivors’ speak of themselves as ‘saved’ by screening.

The patients’ sins In the Bible, when the patient is healed, God must be praised. When he is not, the cause lies in his own sins. Ask people about their responsibility in the onset of their cancer, or myocardial infarction, or diabetes: is it really different nowadays?

Conclusion To fight ‘the harms of too much medicine’, we need to master communication skills and tools and learn from the best.

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