Oikia Bible Institute

October 27, 2023

Oikia Bible Institute

Free Seminary Level Education in Theology and Ministry

OBI is a tuition-free, distance learning certificate program, which adheres to traditional evangelical Christian theology.  Our objective (with local pastoral support) is to equip multiple church members with the necessary skills to rightly divide the word of truth.  We provide the lesson plans and textbooks while the student’s pastor provides hands oversight and discipleship.  All the student needs is the desire to learn. 

http://www.oikiabibleinstitute.com

Church, Worship, and Worshipers

August 29, 2023

Church, Worship, and Worshipers

Rev. Desmond Allen, PhD, MDiv

Aug 2, 2023

I suspect most if not all of orthodox evangelical Christianity would agree that the current state of Western Christendom is in peril.  Herein, I shall define orthodox evangelical Christianity as the adherence to traditional, biblical doctrines derived from a hermeneutic governed by the plain meaning, in common language, of the original, inerrant, God inspired biblical text. 

As predicted in several passages concerning the last days before our Lord’s return, apostasy has crept into the Church, and it is widespread.  Paul warned,

“Now the Spirit speaks expressly, that in the latter times some shall depart from the faith, giving heed to deceitful spirits, and doctrines of demons; Speaking lies in hypocrisy; having their conscience seared with a hot iron” (1Ti 4:1-2).

“In the last days perilous times shall come.  For men shall be lovers of their own selves, covetous, boasters, proud, blasphemers, disobedient to parents, unthankful, unholy, without natural affection, truce breakers, false accusers, incontinent, fierce, despisers of those that are good, traitors, reckless, conceited, lovers of pleasures more than lovers of God; having a form of godliness, but denying the power thereof: from such turn away” (2Ti 3:1-5); also see (2Pe 2:1-3:6).[1]

In the beginning of Jesus’ letters to seven churches in Asia-Minor (the order and messages of which clearly predicts the course of Church history) he is standing in their midst; but when he addresses Laodicea (the wealthy and self-sufficient church of the last period of Church history) Jesus is standing outside, knocking on the door seeking entrance.

“Because you say, I am rich, and increased with goods, and have need of nothing; and know not that you are wretched, and miserable, and poor, and blind, and naked: I counsel you to buy of me gold tried in the fire, that you may be rich; and white clothing, that you may be clothed, and that the shame of your nakedness does not appear; and anoint your eyes with eye salve, that you may see.  As many as I love, I rebuke and chasten: be zealous therefore, and repent.  Behold, I stand at the door, and knock: if any man hears my voice, and opens the door, I will come in to him, and will eat with him, and he with me” (Rev 3:17-20).

The Church is Peril

In our current world, multiple once theologically sound major denominations now deny traditional biblical doctrines.  Many even deny the singular efficacy of Jesus Christ as our sole mean of salvation, thereby fulfilling the apostles’ prophecy that they would “deny the Lord that bought them” (2Pe 2:1).  Some even deny the need for salvation.  Also, as predicted, many have accepted immorality and sexual perversion within their midst.  These rebels have wandered so far from Christianity that one must ask: Why do they even want to call themselves Christian?  Of course the answer is: They are “lovers of pleasures more than lovers of God; having a form of godliness, but denying the power thereof” (2Ti 3:4).  But their actions go yet a step deeper into the depths of rebellion.  As they attempt to dilute and smear the Gospel of our Lord Jesus Christ, by which they hope to silence their conscience and the Word of God, they do the bidding of their master.

A startling 2022 survey of 711 individuals who identified as evangelical Christians reveals just how perverted modern Christendom has become; the percentages were even worse for the 2,300 individual who did not identify as evangelicals.[2]      

  • 48% believe God is capricious, that learns and adapts to circumstances.
  • 65% reject the biblical teaching of original sin.
  • 56% believe God accepts the worship of all religions.  Six year earlier 2016, 48% held this view.
  • 43% believe Jesus was a great teacher but was not God.  Six year earlier in 2016, 30% held this view.
  • 28% believe the Bibles condemnation of homosexuality doesn’t apply today.  Six year earlier in 2016, 19% held this view.

These sad figures are supported by a recent report that the song, “Good Day”, performed by a drag queen, and his album, “Bible Belt Baby”, on which the song is recorded, had hit No. 1 in the iTunes Christian and Gospel chart.[3]

With this dismal state of the Church in these last days in mind, I would like to address three great weaknesses of modern Western Christian culture.  So permeated are these frailties into the fabric of modern Christian culture, they even persist within orthodox evangelical Christianity.  I speak of the worship service format, the venerable church building, and those gathered for worship.  Two of these weaknesses are misnomers—terms often used to signify something other than what Scripture speaks of: one is a noun, the other a verb—church and worship.

The Church

Although it’s common knowledge that the local church consists of the assembled body of believers, the average Christian (much less the populous at large) continually refer to the steepled-building as the church, the house of God, and the pew-filled-room where prayer, singing, celebration, and preaching takes place is called the sanctuary.

Our term, “church” is used to translate the Greek term, ekklesia (ἐκκλησία), which is a compound form of “ek”, signifying “out”, and “klesia” (the root kaléō), “to call”; thus, those who are called out.  The term predates Christianity, so that the historic, pre-Christian meaning spoke of “the regular assembly of the whole body of citizens in a free city-state”.[4]  Jesus was the first to use the term to speak of his followers.  And of course the apostles frequently used the term.  In subsequent years, as Christianity rapidly spread throughout the world, the term eventually became synonymous with an assembly of Christian believers, the called out ones, the chosen, if you will. 

In this respect, the term is used in two ways: First, as mentioned above, to speak of a local assembly of believers—the church. Jesus used this term when addressing a brother who refuses to listen to reason concerning his trespasses, “if he shall neglect to hear them, tell it unto the church” (Mt 18:17).  When addressing Apphia and Archippus in the letter of Philemon, Paul wrote, “to the church in your house” (Phm 2).  And writing to Timothy he spoke of, “how you ought to behave yourself in the house of God, which is the church of the living God, the pillar and ground of the truth” (1Ti 3:14-15)

In the second context we use the capitalized form, Church, to speak of the Church at large; such as the complete body of believers, comprised of all saints from Pentecost till Jesus returns to receive his bride.  We also use it to signify a cohort of associated local church bodies, or a denomination, or even to speak of the collective churches worldwide. 

Concerning the Church at large, Jesus told the apostle, “you are Peter, and upon this rock I will build my Church; and the gates of Hades shall not prevail against it” (Mt 16:18).  When Paul wrote to the Corinthians concerning spiritual gifts, he spoke of the Church in a much larger capacity than that of a mere local assembly when he explained that, “God has set some in the Church, first apostles, secondarily prophets, thirdly teachers, after that miracles, then gifts of healings, helpers, administrators, various kinds of tongues” (1Co 12:28).  And in Hebrews we read, “But you are come unto . . . the general assembly and Church of the firstborn, who are written in heaven, and to God the Judge of all, and to the spirits of just men made perfect” (Heb 12:22-23).

Clearly the church is not the building, neither is the building the house of God.  Neither is any room in such a building a sanctuary of holiness.  Thinking of a building as the church and a room in that building as a sanctuary is a grave misnomer.  It distorts and detracts from the true church, both the local church and the Church universal; and this misnomer is not without dire consequences.  Of primary concern are: 1) This misleading usage leads believers and non-believers alike to think of such a building as a place of holiness and reverence; a place where man goes to meet with God.  When, in truth, man can meet God anywhere; as Jesus said, “where two or three are gathered together in my name, there am I in the midst of them” (Mt 18:20).  2) It usurps the status of believers; not just the nomenclature, but the designation as to where the glory of God resides. 

Although ancient Israel had the greatly revered Holy of Holies wherein the Ark of the Covenant and the power of God resided, Christianity has no such structure.  However, due to the sacrificial death and victorious resurrection of Christ, since the day of Pentecost, the Spirit of God resides within every believer’s heart.  Indeed, the saints are the holy place; both individually and collectively the believers are the temple of God.  The term “saint” is from the Greek term hágos (ἅγος) meaning holy. 

“Greet every saint in Christ Jesus. The brethren who are with me greet you.  All the saints greet you” (Php 4:20-23).     

“Know you not that you are the temple of God, and that the Spirit of God dwells in you? . . . know you not that your body is the temple of the Holy Spirit who is in you, whom you have of God, and you are not your own?  For you are bought with a price: therefore glorify God in your body, and in your spirit, which are God’s” (1Co 3:16; 6:19-20).

“And what agreement has the temple of God with idols?  For you are the temple of the living God; as God has said, I will dwell in them, and walk in them; and I will be their God, and they shall be my people” (2Co 6:16).

As for the origin “church buildings” and “sanctuaries’: The Early Church went hundreds of years without such facilities.  Indeed, due to severe persecution from ten successive Roman emperors, local churches had to meet in private; sometimes even meeting in catacombs where the dead were buried.  But this suddenly changed when Constantine the Great befriended Christianity.  In short order, the Church assumed its new role as a ward of the state.  Soon, the world would be turned upside down as the Church (or at least a corrupt version of it) would come to control the empire. 

It all began just prior to Constantine’s defeat of Maxentius, at the battle of The Milvian Bridge in 312, when Constantine claimed to have a vision.  While looking into the sun he saw a cross of light with the Greek words: ͗Εν τούτῳ νίκα (en toutō nika), “In this sign conquer.” 

As Emperor, Constantine held the title, Pontifex Manimus, the high priest of the college of pontiffs for the ancient pagan Roman religion.  Even after his professed conversion he continued to hold this title as well as continuing to perform its pagan duties.  Because he refused Christian baptism until just prior to his death, the reality of his conversion has always been questioned.  Many considered it merely a brilliant political ploy that sought and succeeded to unite the empire religiously and thereby extend his influence.  Others believe his conversion was real and that he simply appeased the pagans for the same political reasons. 

Whether his conversion was real or not, we don’t know; but one thing is certain, it changed the course of history.  From that day forward Christendom and the empire were entwined; an entanglement that continues to this day with the remnants of the fallen empire. 

Under Constantine’s rule the empire became overtly encouraging toward the Church.  Over the next few decades he instituted many imperial changes such as:

  • In 311, by decree, Christians were granted a limited tolerance. 
  • The edict of Milan in 313 (signed by the co-Emperors Licinius and Constantine) granted all religions, including Christianity, full liberty to follow their faith as desired.  Many have called these the Magna Carta of Christianity; for even their properties, which had been seized by the previous emperor, Diocletian, were restored.
  • In 313 he declared Christian clergy exempt from taxation. 
  • In 314 he assembled the Council of Arles, which dealt with several matters of concern to the budding Imperial Church.  
  • In 321 he issued a decree for the observance of Sunday as a day of worship. 
  • Once Constantine became the sole emperor (having forced the surrender of Maxentius and Licinius in 324, and then their execution in 325), he strongly encouraged his subjects to become followers of the Christian faith. 
  • In 325 he assembled the Council of Nicea—the first General Council of the new Imperial Church. 

Constantine provided large sums of money to support Christian clergy, the circulation of Christian Scriptures and the building of Christian cathedrals, which was a new thing for the hitherto persecuted believers.  He sought Christians to fill his chief advisory posts and, finally, he made certain that his son was given a Christian education.

With the chief of the pagan priests so strongly patronizing and favoring Christianity, it was only natural that other pagan priests would embrace it as well, at least nominally.  As is apparent from the corrupt direction the Imperial Church quickly pursued, the apparent conversion of many of these pagan priests was doubtless motivated merely for political gain, and it wrecked havoc within the Christian community.   

Almost overnight, yesterday’s pagan priests became “Christian priests”.  Like their supreme leader, the Pontifex Maximus, naturally they retained their priestly titles, which heretofore did not exist in Christianity.  With them, also came their temples of worship to their pagan god, Dagon.  Heretofore temples were not a reality in Christian communities.  Suddenly the steepled-church and its sanctuary were born; and they have deceived and misdirected the world ever since.  They have also been a burden of despair and a source division for countless local church bodies over the last 1,500 plus years.  From their birth in paganism, to their mistaken symbolism of holiness, to their source of internal strife over control, there is little positive to be said for these structures.  But tradition prevails, so that even those who know the church is the people and not the building have a hard time releasing it from their grasp.      

Constantine and the aftermath of his actions had a significant affect on the church.  Except for Julian the Apostate (361-363), all subsequent emperors, at least ostensibly, embraced the Church.  In 392, Theodosius the Great decreed that all heathen sacrifices were to be considered treason.  Then in 529, when Justinian the First demanded the school of philosophy in Athens to be closed, outwardly it looked as though Christianity had vanquished paganism.  In truth the new Imperial Church had merely absorbed it, tradition-by-tradition and rite-by-rite, as discussed in the letter to the church in Thyatira, the Church had bedded down with Jezebel.

This marked a decided change in the adversary’s strategy: persecution was exchanged for the infiltration of wolves in sheep’s clothing.  Of course, several centuries later, after so many had rejected the Imperial Church, which was so besieged by wolves, persecution saw a rebirth.  Submit to the Imperial Church or die.  After a couple centuries of the Imperial Church’s persecution of the reformers failed to detract these truth seekers, the persecution subsided and infiltration of false doctrine was kicked into high gear. 

Although the Church has always battled corruption and false doctrines, this latest infiltration has been relentless.  It began with Unitarianism and the rejection of Jesus’ deity in the 1700s, then Darwinism and the rejection of God as Creator in the 1800s, and finally the wide spread rise of atheism and a subsequent attack on basic morality in the 1900s, then onto full blown hedonism and the rejection of all that is moral or sacred in the 2000s.  Today, modern Christendom is in dire straights.    

Even as false doctrines have grown and proliferated over the last few hundred years, there has been a simultaneous growing dearth of theological knowledge among the saints of God; so that fewer and fewer believers have more than a cursory knowledge of biblical doctrines and many fail even to grasp the basics of the faith.    

Worship

The second misnomer is the popular usage of the term “worship”; and perhaps it has even more devastating consequences than does the misuse of “church”.  The primary terms for worship, as well as their contextual usage, have a very specific meaning which speaks to a very specific singular action.  It is an act of reverence—bowing the head or body toward the ground, or even falling prostrate before the power and authority of one greater than oneself.  Although it is used to revere men, angels, idols, false gods, and God, obviously our concern is how it applies to our worship of God. 

Humility

The worship of God is the exact opposite of self pride or narcissism.  Worship requires humility.  Man has a great propensity for pride.  This aspect of the fallen nature, which we’ve inherited from Adam, permeates our species and God finds no pleasure in it.  Indeed, he hates it (Pr 6:17) and deals very sternly with it; “he that has a haughty look and a proud heart will I not endure” (Ps 101:5).

Pride was the original offence of Lucifer, the mighty but rebellious archangel.  In the midst of the passage foretelling his final destruction in Hell, we read this charge against him: “For you have said in your heart, I will ascend into heaven, I will exalt my throne above the stars of God: I will sit also upon the mount of the congregation, in the farthest sides of the north: I will ascend above the heights of the clouds; I will be like the most High” (Isa 14:9-17)

In the end, this once powerful archangel is humiliated, stripped of all power and becomes a mere fellow captive of eternal hell as those whom he had deceived look upon him with contempt. 

I find it very interesting that God designed humanity to be necessarily humbled by numerous aspects of our very being, all of which should keep arrogance in check.  So much so, that if self absorbed narcissists were to truly contemplate the reality of their state, even they would be humbled.  However, I suspect the more pride one harbors the less likely they are to contemplate these humbling features of humanity, for they expose weakness, something the narcissist is loath to admit. 

I speak of the very necessities of life, from eating to defecation, from breathing to our need for water, and from clothing to shelter and even the need of fire.  Some things such as the elimination of bodily wastes are most obvious; but even those aspects of daily life that we thoroughly enjoy, such as eating or drinking, are humbling experiences.  Just go a few days without food and water and see how humbling it is.  It will reveal just how reliant we are upon these external factors which, ultimately are out of our control.  Sure, we can make a quick trip to market, or we can even grow our own crops, but without God’s design the crops will fail and the markets will close; see (Job 38:25-41).[5]     

The Lord warned Israel not to take him for granted or to assume their wealth and bounty was due to their own handiwork. 

“Beware that you forget not the LORD your God, in not keeping his commandments, and his judgments, and his statutes, . . . And you say in your heart, My power and the might of my hand has gotten me this wealth. . . .  And it shall be, if you do at all forget the LORD your God, and walk after other gods, and serve them, and worship them, I testify against you this day that you shall surely perish.  As the nations which the LORD destroys before your face, so shall you perish; because you would not be obedient unto the voice of the LORD your God” (De 8:11-20).

America the Beautiful

Of course America is not ancient Israel; neither Americans nor Christians are recipients of God’s covenant to the Jews.  But the above passage harbors certain principles that are applicable to America’s plight.  For the most part, much of early America attempted to follow biblical morality.  From this country multitudes of Christian missionaries spread throughout the world and God blessed the country with great wealth and power.  But the population soon became arrogant and self confident; neglecting the fact that it is the Lord who provides their strength and blessings.  Soon, the majority of the population was rejecting God and Scripture.  Today, the nation is in trouble, socially, politically, financially, and morally, and it doesn’t take a prognosticator to see that hard times could be just over the horizon.  We saw a harbinger of such hard times during the Great Depression; yet rather than turning to God for relief, the populous at large had grown even further from God.  And like ancient Israel, unless there is repentance and conversion, America is likely to fall to her enemies.      

Humble Moses

It should be no surprise that Moses was one of God’s favorite prophets, arguably even his favorite; for “Moses was very meek, above all the men who were upon the face of the earth” and “the LORD spoke unto Moses face to face, as a man speaks to his friend” (Nu 12:3; Ex 33:11).  The term ʻânâyv  (עָנָיו) is also translated “humble.” 

When Aaron and Miriam spoke out against Moses for having married an Ethiopian woman, they displayed an untoward degree of pride: “Has the LORD indeed spoken only by Moses?  Has he not spoken also by us?” (Nu 12:2).  Immediately, God rebuked them, telling them he speaks to other prophets in dreams and visions, but with Moses “will I speak mouth to mouth, even clearly, and not in dark sayings; and the form of the LORD shall he behold: why then were you not afraid to speak against my servant Moses?” (Nu 12:8).

A few patriarchs and prophets such as Adam and Eve, Abraham, Jacob, Joshua, and Gideon were fortunate to see the pre-incarnate Jesus and speak to him face to face, but Moses experienced more Christophanies[6] than any other person in Scripture.  No doubt these encounters made this humble servant even more so.

One of the most telling passages of Scripture is when Paul speaks of Jesus’ humility: “Let this mind be in you, which was also in Christ Jesus: Who, being in the form of God, thought it not a thing to be grasped to be equal with God: But made himself of no reputation, and took upon him the form of a servant, and was made in the likeness of men: And being found in fashion as a man, he humbled himself, and became obedient unto death, even the death of the cross” (Php 2:5-8).

Right away our minds go to the ultimate humility of Jesus being beaten and mocked and then crucified.  But for this to have meaning; for him to become the propitiation for our sin; he first had to enter his creation as a fellow human; thus, he “took upon him the form of a servant, and was made in the likeness of men”.  As the Son of man, Jesus experienced all the aforementioned humbling features of humanity.  As we read elsewhere, “we have not a high priest who cannot be touched with the feeling of our weaknesses; but was in all points tempted like we are, yet without sin” (Heb 4:15).

The Act of Worship

The primary Hebrew term shachah (שָׁחָה) is used 94 times in the OT.  Similarly, there are three NT Greek terms for worship.  The primary term proskuneo (προσκυνέω) occurs 59 times; and it is the term used by the Septuagint for the aforementioned Hebrew “shachah”.  It conveys the same idea of kissing the hand or the ground, to bow toward or prostrate upon the ground.  While one might physically bow before another human without having the actual mindset of adoration and awe; the worship of God requires both the physical bowing and the conscious, humble, reverential attitude.  The Psalmist said “in your fear will I worship toward your holy temple” (Ps 5:7).  And of Moses, we read that he “made haste, and bowed his head toward the earth, and worshiped” (Ex 34:8)

A classic example of worship (proskuneo) is provided in the heavenly scene where the twenty-four elders (representatives of the redeemed Church) prostate themselves before the Lord: “The four and twenty elders fall down before him that is sitting on the throne, and worship him that lives forever and ever, and cast their crowns before the throne, saying, You are worthy, O Lord, to receive glory and honor and power: for you have created all things, and for your pleasure they are and were created” (Re 4:10-11). 

Paul used this term when reprimanding the Corinthians for their chaotic assemblies. “But if all prophesy, and there come in one that believes not, or one unlearned, he is convicted of all, he is judged of all: And thus are the secrets of his heart made manifest; and so falling down on his face he will worship God, and report that God is in you of a truth” (1Co 14:24-25).

Another, yet less frequent term sebomai (σέβομαι), from the root sebas (σέβας), to fear, is used in a more general way to speak of a life of devotion, religion, reverence.  We see this concept to reference the Thessalonians who received the Gospel, “And some of them believed, and joined Paul and Silas; and of the devout Greeks a great multitude, and of the chief women not a few” (Ac 17:4).  Jesus also used this term to rebuke the Pharisees, “You hypocrites, well did Isaiah prophesy of you, saying, These people draw near unto me with their mouth, and honor me with their lips; but their heart is far from me.  But in vain they do worship me, teaching for doctrines the commandments of men” (Mt 15:7-9).

The third term threskeia (θρησκεία) is only used four times.  The KJV version translates it as religion three times and once as worship.  Similar to “sebomai”, it speaks more to a lifestyle of ceremonial reverence rather than the singular act of humble obeisance, or prostration as do the Hebrew term shachah and the Greek proskuneo. 

Paul used it to defend himself before Agrippa; speaking of the Jews who knew him, he said, “if they would testify, that after the most strict sect of our religion I lived a Pharisee” (Ac 26:5).  And James used it to clarify pure intent, “If any man among you seems to be religious, and bridles not his tongue, but deceives his own heart, this man’s religion is vain.  Pure religion and undefiled before God the Father is this, to visit the fatherless and widows in their affliction, and to keep himself unspotted from the world” (Jas 1:26-27).  

However, in modern Christendom, worship is generally viewed as the activities that transpire during the church service in the perceived sanctuary: prayer, song, celebration, and preaching.  That these activities are identified as worship can hardly be denied when most churches even refer to the song leader as the worship leader or the minister of worship and the service itself is referred to as the worship service.  While very important, and even closely connected with worship, none of these activities, either singularly or collectively, constitute worship in the complete sense; perhaps, least of all, preaching.  Each, or all, can be an aftermath or even a precursor to the singular act of worship; but each can be engaged aside from formal worship. 

For example, although we typically bow our heads in prayer, and some prayers are indeed acts of worship (in that their primary focus is upon God and his awesomeness as we observed with the twenty-four elders before the throne) many, if not most prayers are prayers of request or thanksgiving.  Such prayers are very important but very different than conscious, humble, fear and adoration.  So, while such prayers incorporate half of the concept of worship (the humble bowing of the head), although implied, they lack the conscious singular aspect of fear and adoration.  It’s true that we fear and adore God daily, all day, and even during our prayers; but the singular act of worship, purposefully focused upon God, expressed by fear and adoration, is something different.  Our minds cannot multitask.  We cannot consciously focus upon God in fear and adoration and awe, contemplating his omnipotence, while we are making requests or enumerate our blessings.  The singular act of worship requires the physical lowly posture as well as the undistracted, conscious mental clarity of awe and wonder.  

Yet another activity that is easily mistaken for worship is the act of praise.  Arguably, praise is even closer to the singular act of worship than is the general prayer.   Similar to prayer, some praise (that which is singularly God focused) is indeed worship.  We see this with the twenty-four elders before the throne.  We also see this when Abraham’s servant met Rebekah at the well (Gen 24:26-27, 48).

“The man bowed down his head, and worshiped the LORD.  And he said, “Blessed be the LORD God of my master Abraham, who has not left destitute my master of his mercy and his truth: I being in the way, the LORD led me to the house of my master’s kinsmen.”

A short time later, when he recounts his actions to Rebekah’s father and grandfather, Bethuel and Nahor, he seems to speak of his worship and his praise as two separate actions,  

“And I bowed down my head, and worshiped the LORD, and blessed the LORD God of my master Abraham, who had led me in the right way to take my master’s brother’s daughter unto his son.”

Then, once Bethuel and Nahor agreed to let Rebekah go with him, he worshipped once again, this time there is no mention of praise of thanksgiving, merely his adoration of the Lord: “And it came to pass, that, when Abraham’s servant heard their words, he worshiped the LORD, bowing himself to the earth.” 

The issue with the praise we generally offer during the “worship service” is usually devoid of one half of the act of worship, the physical—the humble act of bowing the head.  Rather, we usually stand or even raise hands toward heaven, giving praise to the Lord.  There is nothing wrong with this form of praise, but it seems more an attitude of celebration than the humble, conscious prostration of the heart expressed by bowing the head.  Furthermore, it generally occurs during a song or in response to a statement from the pulpit.  Again, this is fine; but it’s something different than the singular act of worship, which is purposefully focused upon God, with fear and adoration and complete with the physical bow or prostration.  From such worship, the actions of standing and praising and raising hands and thankfulness and celebration might naturally occur as an aftermath, or perhaps even as a precursor to the act of humble worship. 

As such (as indicated by the terms, sebomai and threskeia), there is a form of worship that constitutes a lifestyle of reverence for God; but (as indicated by the term proskuneo) there is also a specific form of worship, a conscious singular action consisting of the purposeful, and willful humbling of body, mind and spirit to contemplate the awesomeness of God in fear and adoration.  “Jehoshaphat bowed his head with his face to the ground: and all Judah and the inhabitants of Jerusalem fell before the LORD, worshiping the LORD” (2Ch 20:18).  Furthermore, worship should be a regular occurrence; we need not wait till Sunday meeting, and we certainly need not wait till we are in some perceived sanctuary. 

Stuart Hine captured the essence of worship in one of the greatest hymns ever written.  It has it all, the awe and wonder of our Creator and the humble bow of adoration.  Although, in its poetic form the humble bow takes place when Christ returns, clearly the idea is present throughout the poem.     

How Great Thou Art by Stuart Hine

Oh Lord, my God; When I, in awesome wonder
Consider all the worlds Thy hands have made
I see the stars, I hear the rolling thunder
Thy power throughout the universe displayed

And when I think that God, His Son not sparing
Sent Him to die, I scarce can take it in
That on the cross, my burden gladly bearing
He bled and died to take away my sin

When Christ shall come, with shout of acclamation
And take me home, what joy shall fill my heart
Then I shall bow, in humble adoration
And then proclaim, my God, how great Thou art

Then sings my soul, my Savior God to Thee
How great Thou art, how great Thou art
Then sings my soul, my Savior God to Thee
How great Thou art, how great Thou art

The problem with mistaking the activities of a typical modern church service as acts of worship is that we undermine and displace either or both of the core aspects of the singular act of worship—the physical humble bowing of the head or even complete prostration, and/or the willful and purposeful and conscious fear and adoration, awestruck at God’s omnipotence, and his worthiness.  It’s as if in our minds we know the singular act of worship is most important, but in practice we merely reference it almost as an afterthought, as if a sidebar unworthy of the time spent in the main conversation of singing and celebrating and preaching.  

In truth, our church services are too busy to be conducive to the singular act of worship.  This is something for which time must be set aside; it cannot reside in an afterthought or even hover in the atmosphere with an assumed presence.  It is a specific, singular act that demands our full attention.  It is especially difficult for the congregation to pursue quiet, purposeful and conscious humble adoration and the fearful contemplation of God, awestruck at his omnipotence, his love, his worthiness when listening to someone else pray a prayer of request or thanksgiving.  We cannot multitask.  Again, not that such prayers are wrong or uncalled for; indeed, they are welcomed and even necessary.  But their very nature and content make them not conducive to the singular act of worship, in which we consciously focus upon God in fear and adoration, awestruck, considering the omnipotence and worthiness of our King and Creator. 

By equating these other church service activities as worship we do ourselves a grave disservice; for it displaces and robs us of the experience and reality of true and complete worship.  Worship is the spark that gives rise to all these other activities; it is the well from which they spring forth. 

It is especially not conducive to worship when the congregational prayer seems to be more like a mini sermon.  Most services feature numerous prays often by various persons; perhaps we would be better served to begin each service with a prolonged time of silence in which the congregation would bow their heads in awe and purposefully contemplate and focus upon the splendor of God.  No requests, no singing, no celebrating, no speaking; merely a thoughtful quiet time focused upon God and his worthiness.  “Be still, and know that I am God: . . .” (Ps 46:10). 

But being still is not an activity that comes easily to our busy culture filled with amusement and entertainment and activities and news and knowledge to distract us at our fingertips 24/7.  Most of us scarcely know how to spend even a few minutes in silence; and silence in a group setting is akin to silence on the radio station.  It’s not tolerated, somebody must speak; they must say something even if it is a useless thought, but we cannot have dead air.      

Those Gathered to Worship

Lastly, the issue of those gathered for worship.  If you found the previous sections a bit of a challenge to your sense of tradition, you will likely find this section even more so.  Although Jesus and the apostles spoke to individuals concerning salvation, and often preached to public gatherings, Jesus also met with his disciples in private.  He met with the church in private.  Similarly, until the time of Constantine, local church bodies met in private.  Their assemblies were secluded and closed to the general public.  Outsiders, non-believers attended by invitation only.  In these meetings, three primary objectives transpired: worship, the teaching of doctrine, and fellowship.  Of course this did not displace evangelism, but primary evangelism was done outside the church.  As Paul indicated, non-believers could sometimes be present (1Co 14:24).  But these meetings were private and secluded so that an outsider could have only been there by invitation; no doubt these visitors would have expressed interest in the gospel because someone in the church had been witnessing to them. 

The privacy of the church should come as no surprise.  As mentioned above, the Greek term, ekklesia, speaks of the “called out ones, the chosen”.  Church, by definition is comprised of the chosen, those who have placed their faith in Jesus, redeemed by his sacrificial death and alive anew by his glorious resurrection.  By definition, church excludes non-believers.         

While it may appear that the modern approach of opening the doors and indiscriminately inviting the public at large to attend church is a good thing, it is contrary to the way early churches gathered, and it is contrary to the very concept and definition of church.  It is also contrary to the primary purpose of the assembly of saints—to worship, to learn doctrine, and to fellowship. 

Furthermore, this indiscriminate opening of the doors to the general public has proven to produce dire effects.  One of which is that it allows rebels and wolves in sheep’s clothing, false teachers sporting false doctrines.  Even as Jude had warned, “There are certain men crept in unawares, who were before of old ordained to this condemnation, ungodly men, turning the grace of our God into licentiousness, and denying the only Lord God, and our Lord Jesus Christ” (Jude 4).  And as mentioned earlier, such false teachers will increase in the last days.  For this reason, Paul exhorted Timothy, “Therefore Paul charged Timothy, “Preach the word; be diligent in season, out of season; reprove, rebuke, exhort with all longsuffering and doctrine” (2Ti 4:2).

Yet another seemingly good but disruptive aspect to indiscriminately opening the doors to the public with the desire to appeal to the masses is that all too often the church service becomes nothing less than a production of celebration, musical performances, and a shallow three point feel-good sermon presented by persuasive motivational orators.  Worship, in the complete sense, the teaching of biblical theology, and even fellowship are forsaken as the congregation merely sits back to enjoy the show.     

A similar scenario has a slight twist that opting for the weekly evangelical message rather than a shallow three point feel-good sermon.   These sermons, complete with an altar call, are directed toward any possible non-believers who might be present.  As the hook is thrown out for potential converts, time and again the church, the body of believers suffers yet another fruitless meeting; in that (like the recipients of the book of Hebrews) they subsist merely on the milk of the Word.  Hearing the salvation message over and over again, they are never fed the meat of the Word—biblical theology.  The author of Hebrews chided his readers by saying,

We have many things to say, and hard to explain, seeing you are dull of hearing.  For when for the time you ought to be teachers, you have need that one teach you again which be the first principles of the oracles of God; and are become such as have need of milk, and not of solid food.  For every one that uses milk is unskillful in the word of righteousness: for he is a babe.  But solid food belongs to them that are of full age, even those who by reason of use have their senses exercised to discern both good and evil.  Therefore leaving the principles of the doctrine of Christ, let us go on unto maturity; not laying again the foundation of repentance from dead works, and of faith toward God, of the doctrine of baptisms, and of laying on of hands, and of resurrection of the dead, and of eternal judgment” (Heb 5:10 – 6:2). 

Certainly these foundational doctrines are extremely important, but we must move on to deeper things, to biblical concepts that further our spiritual growth and defend the faith.  If the church does not learn sound biblical doctrine and learn to defend it, eventually, as is currently the situation, false doctrines creep in and take root.  The prevalence of shallow three point motivational sermons and/or repetitive basic evangelical sermons within modern orthodox evangelical Christendom has left the Church theologically challenged.

No doubt someone will object, but it is the job of Sunday school to teach doctrine.  I would answer: Our modern format is not how the Early Church conducted their meetings.  The pastors taught doctrine, they did not deliver three point feel-good homilies, and Sunday school is a modern construct.   Furthermore, if this is the job of Sunday school, it is failing.  Not only do relatively few people attend Sunday school, by and large the teachers of Sunday school don’t really know biblical theology and therefore are unable to teach it effectively.  They don’t know biblical theology because by and large their pastors do not teach it to them.

To illustrate this point I cite a survey I conducted while doing doctoral work in seminary.  I had been concerned for some time about the various leadership roles in our modern churches.  The title of my doctoral project was “The Pastoral Neglect to Provide Leading Laymen with a Basic Foundation in Theology.”  To further research this topic I surveyed pastors, and leading laymen of their choice within numerous churches from a certain conservative and evangelical association throughout the states of Oregon and Washington.

I expected to find relatively few pastors providing theological and ministerial training to their lay leadership.  Likewise, I expected to find a fair percentage of the lay leaders to be less than qualified for their task.  However, the results were more staggering than I could have ever imagined.  I felt as if I had peeked behind the facade of neckties, choirs, sermons, beautiful buildings, and spirals reaching to the sky.  I had ripped the mask off a deeply rooted and shameful ugliness.  I had revealed an aspect of western evangelical orthodoxy that is generally shrouded in pretense.  I had uncovered an issue about which most of us would rather plead ignorance or make excuses.  Not willing to confront it face to face, analytically, and honestly, we choose to simply neglect it, and dutifully don our weekly Sunday vesture to mask the embarrassment. 

What had I discovered?  I found that although 97% of the leading layman regularly prepared and taught Bible classes, only 3% of their pastors provided them with hermeneutical training, and less than 20% provided some form of theological training.

Although they admitted to having very little training in theological matters, most of the lay leaders believed they were qualified to teach it.  However, their ignorance soon betrayed itself.  At the end of the questionnaire, I asked them to answer three simple, but pertinent, theological questions.  I didn’t attempt to stump them by choosing particularly difficult topics.  Rather, I chose subjects that have a special concern to anyone who teaches Bible classes or gives spiritual counsel.  Put simply, I chose subjects that anyone doing what they did should know cold.  First, “Why does God allow evil?”  Second, “Define total depravity.”  And third, “In what way is man created in the image of God?”

I didn’t expect lengthy theological treatises or even biblical references.  I merely wanted to see if these teachers had a general understanding of the things they were teaching.  The results were astounding.  Only 24% were able to answer the question as to the image of God.  A mere 16% correctly answered why God allows evil, and no one, not one, could define the meaning of total depravity.  Overall, these leading laymen, these spiritual advisors and pillars in their respective churches, had only 13.5% correct answers, and no one answered all three questions correctly.

Although not comprehensive or conclusive, this small research project had shed light on a great and shameful display of ignorance within the leadership of our local church bodies.  Sadly, our churches are largely filled with lay leaders who have little or no training for the task set before them.  We might say they are the equivalent of a modern day Nicodemus.  How is it, they are teachers of the church and do not know these things? 

In this case, they did not know these things because their pastors had not taught them.  Yet, this is the responsibility of the trained leadership, to nurture and train would-be leaders in the faith so they, too, can effectively fight the enemy.  This means theological training as well as training in ministry, character, and spirit.  Sadly, likely due to the neglect of the pastoral teaching of doctrine in favor of three point motivational homilies or evangelical sermons, these times of unsound doctrine are upon us.  

The bottom line is that indiscriminately opening the doors to the public neglects the very definition of church, and disregards the primary purpose of the assembly of the saints, which is to worship, to learn biblical theology, and to engage in meaningful fellowship. 

Does this mean that outsiders or non-believers are not welcome?  Or course not; but it seems best that such outsides or non-believers should have a personal invitation from a church member.  This was defiantly the situation in the Early Church. 

Paul makes it clear to the Corinthians that meetings should be geared toward enhancing the believer’s knowledge of biblical doctrine and fostering deep relationships within the fellowship.  If perhaps an unbeliever were present and heard these doctrines and prophecies (inspired teachings) he or she might be “convicted of all, he is judged of all: And thus are the secrets of his heart made manifest; and so falling down on his face he will worship God, and report that God is in you of a truth” (1Co 14:24-25).  But as highlighted in the book of Hebrews, these doctrines cannot be if we never get past the foundational doctrine of salvation.  And as warned by the apostle, we must ever be on guard for false teachers creeping into our midst. 

Conclusion

In light of these thoughts, let me say I’m in favor of small, in-home churches focused on proper worship, teaching biblical theology, and strong fellowship with song and celebration and praise.  Herein, theological lessons are taught rather than shallow three point feel-good motivational homilies. 

This does not necessarily rule out large churches or even mega churches; but it would demand a new format.  Perhaps one in which the passive non-participatory sermonic format is replaced by more of a Sunday school concept with smaller classrooms where time is given for quiet thoughtful worship, and sound biblical theology is taught by qualified teachers.  After these sessions of worship and doctrine, all could come together in their grand meeting hall for song and celebration.  One might ask: What does the pastor do if he’s not presenting the hallmark three point sermons?  Aside from teaching one of these advance classes himself, throughout the week he could hold theological and ministerial classes for his leadership—a mini seminary if you will; thereby preparing these leaders to serve and defend the faith.  Pretty much exactly what Paul instructed Timothy to do, “the things that you have heard of me among many witnesses, the same commit to faithful men, who shall be able to teach others also” (2Ti 2:2).        

But I still prefer the small in-home church.  It provides more intimate fellowship and better control of attendance so as to properly defend against false doctrine.  It liberates the church proper (the saints) from the perceived church (the building) and its perceived sanctuary.  It also rids the church of the great and unnecessary cost of maintaining a facility.  By focusing on biblical theology, new qualified leaders will immerge who can purposefully split at the appropriate time to form another in-home church once the membership grows too large.  Once a month, the several small churches that have developed over time could meet together for worship, song and celebration.  They could meet in a field, in a barn, in a tent, in a rented hall at a community center; but thy need not retain what has come to be known as the church and its sanctuary.  They could invite those to whom they have been witnessing; and perhaps one of the pastors could give the coveted evangelical message complete with the altar call. 


[1] 2Pe 2:1-3:6 “There shall be false teachers among you, who shall secretly bring in destructive heresies, even denying the Lord that bought them, and bring upon themselves swift destruction.  And many shall follow their shameful ways; by reason of whom the way of truth shall be evil spoken of.  And through covetousness shall they with false words exploit you: . . . chiefly them that walk after the flesh in the lust of uncleanness, and despise authority.  Presumptuous are they, self-willed, they are not afraid to speak evil of the glorious ones. . . . these, as natural brute beasts, made to be taken and destroyed, speak evil of the things that they understand not; . . .  Spots they are and blemishes, reveling themselves with their own deceivings while they feast with you; Having eyes full of adultery, and that cannot cease from sin; beguiling unstable souls: a heart they have exercised with covetous practices; cursed children:  Who have forsaken the right way, and are gone astray, . . . These are wells without water, clouds that are carried with a tempest; to whom the mist of darkness is reserved forever.  For when they speak great swelling words of vanity, they allure through the lusts of the flesh, through much wantonness, those that have just escaped from them who live in error.  While they promise them liberty, they themselves are the servants of corruption: for of whom a man is overcome, of the same is he brought in bondage. . . . It had been better for them not to have known the way of righteousness, than, after they have known it, to turn from the holy commandment delivered unto them.  But it is happened unto them according to the true proverb: The dog has turned to his own vomit again; and the sow that was washed to her wallowing in the mire.

“Knowing this first, that there shall come in the last days scoffers, walking after their own lusts, And saying, Where is the promise of his coming? for since the fathers fell asleep, all things continue as they were from the beginning of the creation.  For this they willingly are ignorant of, that by the word of God the heavens were of old, and the earth standing out of the water and in the water: By which the world that then was, being overflowed with water, perished”.

[2] Ligonier Ministries. “65% of Evangelicals Believe We’re Born Innocent”, The State of Theology, Oct 8,2022.  https://thestateoftheology.com/ accessed Aug 2, 2023).

[3] Giatti, Ian. “’Flamy Grant’ becomes first drag performer to top Christian music charts on iTunes” Christian Post, Jul 31, 2023 (https://www.christianpost.com/news/drag-performer-flamy-grant-becomes-first-to-top-christian-music.html accessed Aug 2, 2023).).

[4] I.S.B.E.

[5] “Who has divided a channel for the overflowing of waters, or a way for the lightning of thunder; to cause it to rain on the earth, where no man is; on the wilderness, in which there is no man; to satisfy the desolate and waste ground; and to cause the bud of the tender grass to spring forth?  Has the rain a father?  Or who has begotten the drops of dew?  Out of whose womb came the ice?  And the frost from heaven, who has given it birth?  The waters harden like a stone, and the face of the deep is frozen.  Can you bind the cluster of Pleiades, or loose the bands of Orion?  Can you bring forth Mazzaroth in its season?  Or can you guide Arcturus with its children?  Know you the ordinances of heaven?  Can you set their dominion in the earth?  Can you lift up your voice to the clouds, that abundance of waters may cover you?  Can you send lightnings, that they may go, and say unto you, Here we are?  Who has put wisdom in the inward parts?  Or who has given understanding to the heart? Who can number the clouds by wisdom?  Or who can pour out the waterskins of heaven, when the dust grows into clumps, and the clods cleave fast together?  Will you hunt the prey for the lion?  Or satisfy the appetite of the young lions, when they crouch in their dens, and abide in their lairs to lie in wait?  Who provides for the raven its food?  When its young ones cry unto God, they wander about for lack of food” (Job 38:25-41).

[6] Theophanies-God appears or Chritophanies-Christ appears.

Healthcare’s Endemic Problem, Part One

March 17, 2016

The American health care system is touted as the best in the world.  This is a lie.  Certainly it has the resources and the potential to be the best, but the current system, on many levels, prevents this from being the case.  The system is broken, spoiled, fermenting from within, and drunk on its own excess.  Unfortunately, what Congress is presently debating, on both sides of the isle, is merely how best to fund the acquisition of more spoiled grapes when the issue should be: How can we dispose of the rotten and yet retain the good?  In its present, fermented state, the more money we give to health care, the more gluttonous it becomes.

The problem with health care is not how to fund it, or even who should receive it; the problem is what we are funding.  For what we are funding is a system bloated with excess; a system that relies upon its own failure and the employment of misallocated and superfluous billable procedures.

Of course we will not hear the American Medical Association (AMA) or Big Pharma divulge this problem, at least not publicly.  But behind those double doors where “Staff Only” is permitted, these issues of failure, overutilization and misallocation are well-known facts.  The industry relies upon them.  Overutilization and misallocation are so common that if they were to cease, the fiscal foundation of the entire health care industry would crumble.  Therefore, rather than expose this very real problem, the health care industry uses its bully pulpit to cover it up; even to tout the excess as necessity and thus they cry out for even more money.  Sadly, Congress listens.

A fairly recent article in The New England Journal Of Medicine (NEJM), stated, “It has been clear for some time that the primary hurdle to enacting health care reform is figuring out how to pay for it.”[i]  It is this argument upon which the government’s the Affordable Care Act is based.  I take issue with this argument, for it assumes a false premise.  It is based upon the presupposition that the vast amount of health care services currently provided have intrinsic value.  But this presupposition is without support, as noted by the renowned (or infamous depending upon your profession) Robert Mendelsohn, MD, who warned Americans years ago that they did not need “ninety percent or more of Modern Medicine.”[ii]

Until he published this opinion Dr. Mendelsohn had been a well-respected member of the medical community, filling many prestigious roles beyond his pediatric practice.  He had been chairman of the Medical Licensing Committee of Illinois, an instructor at Northwestern University Medical College, an associate professor of pediatrics and community health and preventive medicine at the University of Illinois College of Medicine, president of the National Health Federation, and national director of Project Head Start’s Medical Consultation Service.  Of course, even with these creditials, once he criticized the system, he was immediatelly ostracized.

I do, however, agree with another observation in the NEJM article, “great savings could be achievable in two areas: administrative costs and unnecessary care.”[iii]  Where I differ is the nature and volume of the administrative costs and unnecessary care that could be purged.  The article’s focus is limited to extreme clinical misallocation and fraud, which is estimated at $830 billion (30%) and another $500 billion (20%) in administrative costs.  I, on the other hand, focus on the routine, ubiquitous excess that drives the current medical system, that which constitutes its financial backbone, the 90% of unnecessary care Dr. Mendelsohn discussed.  Using these figures, controlling this waste could realize a savings of perhaps $2.5 trillion in clinical costs and another $2.3 trillion in administrative costs. If orchestrated effectively, the savings generated by eliminating this waste would be such that health care cost for the entire nation would be but a small fraction of its current expenditure.  From this premise, it is clear that true health care reform must take place at the clinical level, not the fiscal.  Reforming insurance policies and tax codes will only further exacerbate the problem of overutilization and fraud which are consuming our fiscal resources faster than we can produce them.

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[i]. RA Levine, “Fiscal responsibility and health care reform,” The New England Journal Of Medicine, Vol. 361, Issue 11 (Sep 10, 2009) 1533-4406.

[ii]. Robert S Mendelsohn, Confessions of a Medical Heretic (Chicago, IL: Contemporary Books; 1979), xiii.

[iii]. RA Levine.

My Love-Hate Relationship With Healthcare

March 8, 2016

As a seasoned clinical respiratory therapist and clinical manager with an advanced degree in health care management, I have developed a love-hate relationship with allopathic medicine.

The Bright Side

I love the advanced technologies and medical interventions that can change and literally save lives.  Many times, I have been part of an emergent health care team employing such advanced technologies and medical interventions in various life-threatening situations.  I have witnessed seemingly miraculous recoveries—people virtually coming back to life when none of us thought it possible, or at the very least, probable.

Years ago, I participated in the mechanical ventilation of a patient, who for several weeks had been virtually on the verge of death—showing no signs of cognitive function, which was confirmed by multiple unpromising EEGs suggesting irreversible brain damage.  Then (and this is not typical), when all hope was gone and everyone knew it was way past time to pull the plug, a glimmer of consciousness appeared.  Slowly, day by day, we watched his life return.  First, his eyes began to make contact with ours.  After a week or so, his eyes began to follow us as we walked about the room.  Within a couple of weeks his eyes began to respond to our questions.  Then his head began to move, and one day, he mumbled a few words.  Soon he was talking.  Eventually, he walked out the door.

A few years before that I participated in the nearly hour-long CPR of a 12 year-old girl, whom, it was believed, had an allergic reaction to anesthesia.  After exhausting every possible option without results, her condition continued to deteriorate until her heart simply would not beat at all, not even erratically.  At last, we were mere seconds away from giving up; the discussion to cease our efforts had already begun, when suddenly her heart began to beat with a regular rhythm.  She has since grown into a beautiful young lady.

More than twenty years ago, I managed the ventilation of a middle-aged man ravaged by disseminated intravascular coagulation (DIC); it was to a degree that none of us had ever seen, consuming every limb and much of his torso.  We all knew he could not survive.  Days turned into weeks and somehow he was still hanging on.  Then he started getting better, the DIC reversing.  But after several days of promise he suddenly took another turn for the worse.  Again the DIC started to spread, though not as extensively as it had the first time.  Once again his condition looked dire; and then, after several days, the DIC began to reverse again.  He was eventually discharged, minus one leg.  I watched him hobble to the car on his new crutches.

Many medical procedures and medications are all but miraculous; and, as one who administers some of these services, it is an honor to be part of them.  I love that part of medicine.  I also love the genuine compassion and personal sacrifice on the part of the caregivers.  Most doctors, nurses and therapists of various disciplines, enter the medical field with a true desire to help, to make a difference in society.  Through the years, I have watched many of them weep (I have wept) when faced with the realization that nothing more could be done for their patient, and death was imminent.

I have heard physicians chastise uninsured patients for neglecting their office visit simply because they had no money to pay for the service.  They would assure the patient that their health was more important than the ability to pay.  I knew one physician who paid the cable bills for several of his nursing home patients because they could not afford it themselves.  I love that part of medicine, the human part, the empathy, the concern, the desire to make a difference.

The Dark Side

But there is also a part of medicine that I hate.  It is the dark side.  It is ever before us but seldom discussed; and it runs deeper, far deeper, than the benevolent bright side.  It is the white collar criminal element, endemic, even intrinsic to the system.  Without this element the current system (even under the Affordable Care Act) would simply implode.

I hate the misinformation, the widespread misallocation of resources and the fraud upon which the system is structured.  But this is only one aspect of this convoluted system, for it is broken at virtually every level.  In the following pages I attempt to peel back these layers and expose this system for what it is.  Some harsh things are said about the system, and consequently, about physicians; but I want the reader to understand this is not so much a condemnation of physicians as it is of the system of which they (and all of us really) have necessarily become a part.

As for the hint of sarcasm and cynicism strewn across these pages, it is not without cause.  From both a professional and a personal vantage point, through the years I have developed a very healthy sense of skepticism toward the dogma of allopathic medicine (western medicine).  For both your personal wellbeing and your financial stability, I would advise you to do the same.  Barring a relatively few and some nearly miraculous procedures, the majority of services provided by allopathic medicine are anything but honorable, or even necessary for that matter.  Not that particular services or procedures are themselves without value, but their superfluous and careless use, whereby they are employed without sufficient cause are, indeed, without value.  Not only does this create additional expenditures, it fills the patient with false hope and misinformation.

Having carefully considered the many troublesome layers to America’s health care system, I believe I have the answer to this dilemma.  The solution does not reshape the system but replaces it all together.  And I do mean altogether, the clinical as well as the fiscal elements.  However, I truly doubt those legislators with the power to fix this debacle seriously want to know the cure.  The cure is not a matter of resources but a matter of clinical reform—a reform that must initiated via legislation. It would be controversial legislation for it would affect one of Capitol Hill’s greatest lobbying groups: the pharmaceutical industry and its plethora of dealers—AKA, medical doctors.  Therefore, I suspect the cure is not welcome.

Furthermore, this work indicts the American medical establishment for its conscious and unethical neglect of promoting health; and, even worse, for actively engaging in the destruction of the same, by ignoring and even opposing proven natural therapies while promoting useless, yet profitable, medications that it might advance its own self-serving agenda of self-preservation.  Although many physicians at the clinical level might be excused for unwittingly disseminating misinformation, the medical establishment which knowingly advances this misinformation cannot; and be not deceived, this medical establishment is a very real and elite society of powerful movers and shakers within, or closely tied to, the pharmaceutical industry, which is the driving force behind our health care system.

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Congress Has No Desire To Fix Our Broken Healthcare System

March 8, 2016

America’s health care system is broken and nothing Congress has done, is doing, plans to do, or has even debated, will fix it.  The fervent arguments from either side of the isle are fallacious; for neither address the crux of the matter.  It is not who should have access to health care, or even how to pay for it; the issue of concern must be the health system itself, which is grossly bloated with misallocated resources and fraudulent services.  So that (and I say this without hyperbole) the vast majority of dollars spent on health care pay for an unimaginable volume of absolutely unwarranted doctor’s office visits, medical tests, hospitalizations, and medications that accomplish little more than to fill the coffers of service providers.

The health care system is not merely riddled with overutilization, misallocation, and fraud, but these form the framework upon which the entire system is built.  These are the foundation of the medical economy.  If taxpayers knew the extent of superfluous, gratuitous and fraudulent health care procedures and services I am certain they would force politicians to fix it.  It is so bad that if politicians truly understood the degree of waste and fraud, they might even be tempted to fix it themselves.

I submit that the health care system itself is sick, terminally ill. Like an irreparable myopathic heart, hopelessly destroyed by disease, no amount of money can cure this sick system.  More personnel cannot cure it.  Better trained clinicians cannot cure it.  It needs to be replaced.  It must be cut away and a new system put in its place.  Herein, I suggest a viable replacement, a new system that would provide necessary health care to all.  But it will take an act of Congress, for many laws concerning medical service providers and reimbursement for medical services must be changed.  The current medical system will fight it to the bitter end. So too will the medical malpractice trial lawyers, for the cash cow from which both of them suck will be removed.

One day, in my frustration at a couple of physicians admitting more patients to the hospital (unnecessarily so) and writing useless medical orders for unwarranted services,  I said, “If we would only admit truly sick patients to the hospital, and only provide the services that were necessary, the whole country could have affordable health care.”

One of them responded, “I know, but everybody wants their money: the doctors, the hospitals, the pharmacies; everybody wants to make money.  We have to do this to keep the system going.”  They both chuckled, brushing it off as if it were merely a game they played.

With more than four decades of clinical and managerial experience in the medical system, I am speaking out, blowing the whistle, and biting the hand that feeds me.  Not that I haven’t spoken out before.  Indeed, I’ve been speaking out for decades, writing articles, doing radio shows and even writing a previous book on the topic.  But in light of the newly passed legislation of the Affordable Care Act, I felt I had to speak up yet again because this monstrosity of a mess is merely going to increase the already bloated system of misallocated and fraudulent medical service.  I hope someone listens.

Hopefully, at the very least, these blogs will cast enough light on the severity of this fixable problem to get people thinking and talking about it.  Reader’s Digest often publishes an article entitled something like, “Twenty Things some profession Will Not Tell You;” and they have published one about physicians.  But they left out the most important one, which virtually every physician knows but will absolutely not tell the public.  “If they provided only that medical care which is necessary and beneficial, the total cost of quality health care in America would be a very small fraction of the current exorbitant cost.”  The problem is that such a practice would put most of them out of business.  It is the current high volume of unwarranted, superfluous medical services (provided largely to the minority of the population) that keeps their practices thriving.  The foundation of America’s healthcare system is rooted in this sanctioned waste fraud and systemic abuse.

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Lower Taxes and Provide Universal Healthcare

September 7, 2009

True healthcare reform must start at the clinical level.  The medical system itself is broken and no amount of money alone, from any source, can fix it.  After briefly identifying certain clinical issues that must be addressed, I propose the specific financial and clinical reforms that could solve our national healthcare crisis.  These reforms would reduce the present tax burden while simultaneously providing free hospitalization and catastrophic healthcare coverage to every American.

The combined volume of conveniently over-utilized to blatantly fraudulent services — spawned by our convoluted pay-per-service reimbursement paradigm, controlled by virtually unregulated medical doctors — has created a medical system that knowingly exists and even thrives on the misappropriation of resources.  So that the over-utilized/fraudulent services of this obscenely bloated system far outweigh the relatively small volume of useful and essential services it provides.

Unfortunately, what Congress is presently debating is merely how best to fund the acquisition of more sour grapes, when the issue should be how can we dispose of the sour grapes and eat only the good?  In its present form, the more money we throw at healthcare, the more gluttonous it will become for the sour grapes.

You will not hear these truths from the AMA or any other physicians’ group.  They are so ingrained in and dependent upon these over-utilized/fraudulent services that asking their advice on reform is like asking a committee of foxes how to fix the hen house.  But there are individual physicians and nurses and therapists who speak up from time to time; essentially marking themselves as whistleblowers.  As a therapist with three decades of clinical experience and a PhD in health administration, I know firsthand how the medical industry is fleecing America with countless misallocated diagnostic tests, inappropriate treatments and superfluous hospitalizations of “patients” whose primary problem is having shown up for a doctor’s visit on a day their doctor had a few hospital beds to fill.

Over-utilized and Fraudulent Services

An effective healthcare reform must address the following clinical issues.  Any attempted reform that avoids these issues will merely complicate and worsen the problem.  First on the agenda are the vast majority of medical services ranging from menial to completely unnecessary.  For example, most doctors’ office visits are for frivolous matters such as post nasal drip or a common cold.  At the same time, the vast majority of hospitalizations are just as frivolous, even fraudulent; with far too many patients admitted for a wide range of general symptoms or conditions that could easily be treated at home.  Or just as fraudulent, patients are hospitalized with an untreatable, end-stage disease that should be treated with palliative care by the hospice system, or simply in a nursing home.

Most hospitalized patients (both those who merely have the misfortune of visiting their physician on a day hospital beds needed to be filled, and those at the end of their life who simply need the palliative care of hospice) will endure a series of unnecessary tests; tests that require a physician’s interpretation, which, of course is a separate billable item.  And of course they will receive a daily visit from their physician (another separate and quite costly billable item), and probably even get a consult visit from a specialist (another costly billable item).

You do not have to be a physician to recognize questionable routine practices such as daily serial EKGs on a 92 year old suffering severe and chronic dementia.  Although the physician only receives $10.00 for each EKG interpretation, when we consider that even in a small rural hospital this may total 30 to 50, largely unnecessary, tests every day, we realize this is a considerable sum.  Especially once we know the physician’s interpretation might merely be dictated from the EKG machine’s automated analysis.  Without his knowledge, I once timed a physician as he interpreted/dictated 33 EKGs in less that three minutes.  That translated into $330.00 for less than 3 minutes of reading.  Later that day he had another stack to “interpret.”  This happens daily in every hospital and clinic in America; and EKG’s interpretation is the least lucrative fee of the many tests that require a physician’s interpretation.  Other studies such as PFTs, EEGs, ultrasounds, MRI’s, sleep studies, CAT scans and numerous other x-rays, each command an interpretation fee above and beyond the cost of the test, some fees being hundreds of dollars.

Preceding the interpretation are many tests and test facilities that are totally worthless; nothing short of perpetual scams perpetrated on the American public.  Like any good scam our healthcare industry provides just enough truth and reality to make it appear legitimate; but behind the white coats and closed doors, at both the administrative and the clinical levels, is a world of deceit and fraud.  Not that the fraud is overtly illegal (most of it anyway); but it is definitely overtly unethical.  And it is not that the primary players have conspired to perpetrate this scam; not that most of them are even aware of their involvement.  But the scam is there none the less, with many of the perpetrators themselves being willingly deceived; for after all, it is their livelihood.

Two examples of many such scams are the Sleep lab and the ill-equipped cardiac cauterization lab; both of which exist to meet the needs of special interest lobbyist, not patients.  Sleep labs, for example, are lavishly designed to record EEG readings to determine the presence of sleep apnea.  A worthwhile cause except all that is really needed to make a definitive diagnosis is simply to watch the patient sleep while recording his/her oxygenation level with an inexpensive pulse oximeter; or even easier, just ask the patient’s spouse if he/she has periods of apnea while sleeping.  CPAP machines, used to treat this condition, have an automatic mode, which dynamically adjusts settings to the patients need; so that no one, not even the physician, needs to determine the optimal setting for treatment.  Even worse, for they can be lethal, is the multitude of minimally equipped cardiac cauterization labs throughout the county.  I say minimally equipped because they are not prepared, either with the necessary equipment or the necessary surgeons, to provide subsequent treatment, if necessary.  Here, the procedures are merely elective and explorative; and very dangerous.  If a condition is found that needs treatment the patient must be sent, often by ambulance, to a facility that can actually provide treatment; once, of course, the procedure is repeated.  Needless to say, none of the staff, or their family members, at these facilities would consider having such procedures done at their own little lab.  They would go straight to the facility that could treat them.

Then there are the now ritualistic, mostly useless, and always expensive, heroic procedures that nearly every dying person must endure.  While these procedures can work quite well on certain patients, they do not work for everyone, or even most everyones.  The fact is they seldom work at all; and when they do work it is on relatively health patients who happened to suffer a sudden injury of medical mishap.  They definitely do not work well on those for those with advanced end-of-life degenerative diseases, nor advanced diseases involving multiple body systems.  In the end the extraneous and misallocated use of these procedures is a gruesome and unethical process that does nothing more than offer cruel and false hope to the patients and their loved ones, while filling the pockets of the “caregivers”.   Our modern technologies are amazing, but they are not appropriate for everyone and thus have created some decidedly ethical issues.  We must come to grip with the fact that these technologies need not be employed in futilely simply because we have them.  As amazing as they are, they cannot stop the dying from dying.

Herein lays the single most important issue for resolving America’s healthcare crises; putting an end to abuse: from frivolous offices visits to unwarranted hospitalizations and the over-utilization and misallocation of advanced technologies and diagnostic procedures.  While a fraction of modern medical services are essential, the vast majority of allocated services are unwarranted and even useless.

Pharmaceutical Gatekeepers

The second clinical issue of concern is the role of the largely useless pharmaceutical gatekeeper (i.e. the physician).  Although many patients already know what medication they need, they must still go through the legislated and nothing less than bureaucratic hoop of seeing the pharmaceutical gatekeeper for a prescription.  Up to 70% of the gatekeepers prescribe what the client asks for.  Those patients who do not know what they need, if anything at all, can find out from many sources other than the mandated gatekeeper (who by the way misdiagnoses from 40% to 60%60% [i]  of the time and can make incorrect prescriptions up to 71% of the time). [ii]

Indeed, as we see in the next point of discussion, well-informed patients often know more about their condition than does their physician.  Forcing everyone to conform to the ritual of seeing the pharmaceutical gatekeepers is an enormous waste of cash that largely does little more than feed the foxes.

Medical Education

The third clinical issue of concern is the absolutely inept medical education provided by all medical colleges; including the big name schools.  While there are some very skilled surgeons and diagnostic physicians, this is not the norm.  They are indeed the minority among their peers.  And they will gain their skills and advanced knowledge after medical school, not during it.

It is not merely the previously mentioned, ill-equipped, cardiac cauterization labs that hospital staff members in-the-know avoid for their personal treatment; such staff members also avoid the majority of physicians on staff.  In many facilities, if said staff members have a serious medical condition, they are likely to avoid the entire medical staff and seek treatment elsewhere.  Unfortunately, they are not allowed to alert or worn patients with their inside knowledge.  No matter how inept a patient’s physician might be staff members must bite their lip, put on a good face and promote confidence in the physician.  The stress of this daily thespian role when other’s health and even lives are at stake causes many simply to leave the medical field altogether.

As demonstrated by Abraham Flexner’s 1910 report, the pitiful state of the medical education model is well known.  Because of his scathing report medical schools were eventually attached to the universities.  Unfortunately, while a general university education was added, nothing significant in the actual medical education changed.  Medical school lasts no longer today than it did more than 100 years ago (even before surgeons realized they should wash their hands between surgeries).  And admission requirements for most medical colleges are minimal at best; none requires a master’s degree and most do not even require a bachelor’s degree.  Except for the 25 or so medical colleges that actually admit students directly from high school, admissions requirements generally include a few years of college with a few specific science classes and (barring the competitive big name schools) an ever so modest GPA – a GPA that would not qualify for most master’s degree programs.  And a requisite GPA for graduation is virtually none existent; in that most medical schools have converted to a simple satisfactory/unsatisfactory grading system.

Due to the inferior and incomplete nature of the medical education, graduates are necessarily incompetent; and sadly, most doctors seldom bother to learn much more than that which was required of them in medical school.  All medical schools (including the big name colleges) have virtually the same program: two years of rote memory (this is the extent of the academic learning), and either one year or two years of clinical clerkships (basically, job shadowing).  Now they graduate and become licensed physicians.  The subsequent year of internship (little more than a fraternal hazing), and a few years of residency (on-the-job-training) in a teaching hospital are served as licensed professionals being paid (albeit meagerly) for their services.  Like all OJTs their primary objective is production verses education.

Medical knowledge has advanced far beyond what was known when Flexner submitted his report, but still medical college is the same meager two years of academic work and one or two years of clerkships.  Today, the physical therapist has a doctorate degree with more postgraduate academic education than does the medical doctorate.  So too does the pharmacist with his requisite doctorate.  Even nurse practitioners, with master’s degrees have as much or more postgraduate academic education as the medical doctor; yet merely due to legislation, certainly not expertise, the MD continues to control healthcare; and, as previously mentioned, in a virtually unregulated process.

Because the primary purpose of the medical degree is to train pharmaceutical gatekeepers, evidently it is deemed that further education is unnecessary.  The current nature of this role satisfies the system: diagnose, prescribe a pharmaceutical, bill for services.  Correct or incorrect, the diagnosis and prescription seem secondary to the act itself.  As a result litigation is rampant; and it is not all or even mostly frivolous.  Largely, it is for good cause.  Medical error is one thing; medical incompetence is another, and it abounds.

For example, and on an admittedly anecdotal note, I once suggested to a physician that we ship his very sick early middle-aged patient to a larger hospital, a medical center that would be better equipped to deal with the ARDS.  He replied, “No, it wouldn’t make any difference, we (i.e. physicians) are all just guessing, none of us know what we are doing.”  Now you might think this is an isolated case, but from more than thirty years experience in critical care I can tell you that other than the use of the superlative modifier “none” he was largely correct.  Literally, most physicians have no clue as how best to treat ARDS; but there are some scattered around the country with established strategies that, although not always successful, certainly increase the patient’s chances of survival.  Needless to say this particular patient was not one of the survivors.

 

Proposed Pharmaceutical Reforms

I propose healthcare reform should take place in the following manner.  First, deregulate pharmaceuticals.  Other than narcotics and certain concentrated poisons, patients should be able to treat themselves if they so choose; thus, making a patient’s visit to a pharmaceutical gatekeeper largely optional.  Simultaneously, pharmaceuticals should be made readily affordable; largely by opening up the free market.  Shorten the current length of pharmaceutical patents.  Do away with all patent renewals; and refuse additional patents for minor variations and additional uses of an already patented drug.

Proposed Medical Doctorate Reform

Secondly, to take care of the truly critically ill and patients in need of hospitalization, a genuine academic doctorate of medicine must be instituted; perhaps the MD, PhD CC (doctor of medicine, doctor of philosophy in critical care).  This advanced degree would require another 4 years of intense academic and clinical work beyond the present minimally educated MD.  These MD PhD CCs would take care of the critically ill and hospitalized patients while the MDs cared for the lesser, common conditions of those who chose to see them.

Proposed Reform to Achieve Optimal Care

Thirdly, to contain over-utilization and promote optimal care, hospitals would pay the MD PhD CCs handsomely for their time; versus the current system that pays MDs handsomely for their piecemeal, individually-billed services, which fosters fraud and over-utilization.  And just as important; proven medically effective protocols (for both hospitalization and treatment) would be instituted to replace the historic and often haphazard physician’s-personal-opinion method of medical treatment.  These protocols would be constructed by and subject to a centralized peer review panel consisting of experts form several disciplines within the medical community: physicians, nurses, therapists, economists, administrators and ombudsmen.

Hospitals would be reimbursed solely by federal funds.  However, it must be noted that by arresting the volume of over-utilization and fraudulent services (which currently account for the majority of care provided), the requisite funds would be substantially less than the present cost.

If they so choose, for an out of pocket fee (or a privately paid insurance fee) patients could consult private physicians, or nurse practitioners, or nutritionists to attend to their lesser and common medical issues.  However, because most pharmaceuticals would be accessible to the public, these visits would be optional.  And because no federal funds would be available to these practitioners the market would be competitive and affordable to the average citizen.

Thus, the savings realized from appropriate utilization and public access to affordable pharmaceuticals (without having to see the gatekeeper), would lower the current tax burden while permitting everyone to receive free catastrophic healthcare and hospitalization.

To implement this reform immediately, a coalition of prominent physicians and surgeons from major universities and hospitals, could select those physicians and surgeons to be grandfathered in as the first of the new breed of MD, PhD CCs.

Conclusion

The aforementioned reforms would improve the entire healthcare industry on all fronts.  Standardized protocols, implemented by physicians truly trained for the task, would maximize care to hospitalized and critically ill patients, contain cost by preventing over-utilization and outright fraud; and decrease frivolous as well as legitimate litigation.  Allowing the public to take charge of their own health by providing affordable and accessible medications without the bureaucratic approval of a pharmaceutical gatekeeper would revolutionize our national health status.  Most people are not stupid; and the argument that physicians must supervise the prescription of medications is old and worn out.  As evidenced by traditional and current medical practice (that is virtually incorrect as often as it is correct) physician control is clearly not an efficient or effective model.  In all, the implementation of such reforms would drastically change both the economics and the quality of healthcare for the better.

Debunking The Healthcare Debacle - biting the hand that feeds me

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ENDNOTES


[i]. Kirch, Wilhelm and Schafii, Christine.  Misdiagnosis at a University Hospital in 4 Medical Eras Report on 400 Cases.  MEDICINE. 1996;75(1):29-35.

[ii]. Chassin, Mark R, Galvin Robert W.  The urgent need to improve healthcare quality.  JAMA 1998 Sep;280,11,1000, p. 1004.


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