Christians and alternative medicine

I recently came across a Christian discussion over complementary and alternative medicine (CAM). For what it's worth, if anything, here are some of my thoughts:

1. It seems to me lots of companies use various buzzwords to try to get people to buy their products without necessarily advocating an entire belief system behind these buzzwords. For them, it's not really about the worldview, but it's about making money. So they'll market it in whatever way will net them the most profit. In other words, even if it's true a CAM company markets their products with various buzzwords taken from Hinduism or Eastern medicine or wherever else, it doesn't necessarily mean the company itself is going to push Hinduism or Eastern religion or philosophy on people.

2. Plus, doesn't this reflect the culture and society we live in rather than the company, per se? It seems they're just trying to make money using popular cultural buzzwords like "aura" and "karma" and so on to sell their stuff.

3. But maybe I'm wrong. While I would think such a company would be happy to sell their products with or without various buzzwords, but maybe they really do want their sales people or those who partner to sell their products to also push their entire philosophy and practice. If so, then I'd steer clear.

4. Of course, every company has a certain culture. For instance, I have a friend who works in the video game industry. And I've visited several different video game companies as well as huge events like E3 more than once. I'd agree with a lot of this Wiki article on video game culture, and I'm sure video game companies are saturated with a lot of this too.

   Now, if a Christian works for a CAM company, how will the CAM company's culture affect them? That's a consideration.

5. Some Christians seem almost superstitious in how much power they think CAMs have over us, weaving grand conspiracy theories about how the New Age or Eastern mysticism is entering the church through working for such companies.

   (Interestingly, many of these Christians are also cessationists, and think modern miracle workers are nothing more than charlatans.)

   But if they wish to warn Christians about buying or selling CAM products, or about working for a CAM company, wouldn't a more simple and direct reason be because it's unwise to partner with companies that are more like slick snake oil salesmen trying to make a quick buck? Why strain to make it all about the New Age, Eastern mysticism, and the like - these are so far from evident?

6. CAMs are very diverse in their medical efficacy. Some are good, some are bad, some are neutral.

   For others the jury's still out since the evidence is inconclusive.

   There's also the placebo effect to take into consideration.

   For example, homeopathic medicines (despite having "scientific" journals of homeopathy) are basically like 99 parts water to 1 part "medicine." These days, the dose of the "medicine" in the solution (assuming it would even be effective in the first place if given in an appropriate dose) is far too small to have an effect - beneficial or deleterious. So the joke with homeopathy is people are just drinking very expensive water. Perceived benefits are pretty much attrbuted to the placebo effect from what I understand.

7. I think most physicians would advise against a particular CAM if it's bad. Or if it's in place of actual medicine. Like a lot of people who have cancer want to explore this or that CAM instead of getting chemotherapy or surgery or whatever (e.g. Steve Jobs).

8. As a side note, lots of CAM people say Western doctors don't know anything about CAMs. Maybe that was true in the past. I don't know. But today many if not most physicians like oncologists are taught and educated about CAMs in order to be very familiar with them since so many patients ask about them.

9. There are some people or companies that push CAMs like herbal medications or massages in the context of a bad religious system or strange worldview or something like that. I would avoid these. But it seems to me most are more than happy to take people's money without talking about their own beliefs or hooking people into some weird New Age cult!

10. Perhaps a bigger problem is some CAMs are intertwined closely with certain philosophies or worldviews.

    Take acupuncture. Traditionally, acupuncture involves the idea of qi, yin/yang, and the five elements.

    Presumably this still exists in various parts of Asia and among certain acupuncturists in the US.

    But that's not necessarily the case in some modern practices of acupuncture.

    And it's possible to have acupuncture without buying into the underlying philosophy. Similarly it's possible to practice yoga stretches without buying into Hinduism or Buddhism.

    Also, my impression is, although the evidence is debatable, and much of it attributable to the placebo effect, there does seem to be some slight scientific evidence for some acupuncture. I'd have to read up on this to be sure though.

    I'm guessing doing nerve blocks to relieve pain (which doctors like anesthesiologists, critical care physicians, and emergency doctors can do) is similar to some parts of acupuncture.

11. There are some doctors who are quite secular (e.g. Steven Novella). But does seeing a secular physician mean one is necessarily buying into secularism?

Homsexual Christians, marriage, and sexuality

Several thoughts on homosexual converts to Christianity, sexuality, and marriage in no particular order:

1. I understand if pastors aren't comfortable discussing these issues. It gets to be fairly explicit, and some women might find it offensive. But if we're going to have an honest discussion about the lifestyle of homosexual converts to Christianity, consistent with biblical sexual norms, I think we need to explore whether the current options aren't narrowly idealistic.

2. For discussion purposes, let's stipulate that some homosexual men genuinely convert to Christianity, but they aren't physically attracted to women, and they retain a physical attraction to men, although it's not overpowering.

   How should the church counsel them?

   Currently, there seem to be three popular options:

   a. The liberal position, according to which homosexual activity is morally acceptable. We can summarily take that off the table.

   Among conservative evangelicals, there are two popular alternatives:

   b. Undergo reparative therapy. If successful, marry a woman.

   c. Lead a celibate lifestyle if you aren't attracted to women.

3. However the latter two are in tension with something else conservative evangelicals often say. Conservative evangelicals frequently criticize the romantic model of marriage. They raise two objections:

   a. Falling in love is not an adequate basis for a stable marriage.

   b. The Bible takes a more pragmatic view of marriage.

4. However, if we accept b, then it's no longer clear why a homosexual convert to Christianity shouldn't marry a woman even if he lacks a normal man's attraction to a woman.

5. There are additional considerations. To be blunt, a man finds sexual intercourse enjoyable even if he doesn't find the woman attractive. So, at a purely physical level, even a homosexual man ought to find sexual intercourse physically satisfying.

   Indeed, active homosexual men resort to alternatives which approximate sexual intercourse.

6. In addition, it's possible for a man to deeply love a woman even when there's no sexual attraction involved. Paradigm cases involve men who love their mothers, grandmothers, and sisters.

   In theory, it would be a possible for a convert to Christianity to truly love his wife without having a sense of romantic affection.

7. One objection is that even if that worked out for the husband, it would be unfair to the wife. She wouldn't be getting as much out of the relationship. What about that?

   a. Certainly there should be informed consent. If a homosexual convert to Christianity wants to marry a woman, he should be forthcoming about what he brings to the marriage.

   b. In my observation, popular stereotypes notwithstanding, men are generally more romantic than women. I don't think it's unusual to have a marriage in which the husband loves his wife more than she loves him. (Of course, that's unfortunate.)

   Likewise, women are often fairly pragmatic in their choice of a mate. A man chooses a woman for the woman, whereas a woman often takes other factors into consideration when choosing a man, viz., is he a reliable breadwinner?

   c. A certain percentage of marriages settle into something more like roommates. They stay together to avoid loneliness, but it's not as if they are deeply in love with each other.

   I don't say that's a good thing, but as a practical matter, there's often a stark contrast between the marital ideal and the marital reality.

   Likewise, you have marriages which evolve. The couple may be crazy about each other for the first few years. Then the wear-and-tear of marriage takes its toll. But if they stick it out, the love may deepen.

8. Although it's controversial to mention this, I daresay women can find sexual intercourse physically enjoyable even if she doesn't find the man attractive. For one thing, most women are sexually active, even though the husband isn't matinee idol material.

   I'm not a gynecologist or urologist, so I may be wrong about this, but I suspect the stereotypical impression that men are less discriminating about sex than women is based on faulty assumptions:

   a. To my knowledge, foreplay is more important to women than men because women need some lead-time. Without vaginal lubrication, intercourse is uncomfortable for women. Put another way, men have a hair-trigger sexual arousal mechanism. In that sense, men are always ready for sex in a way that women are not. But that's somewhat misleading, because it's a question of timing.

   b. From what I've read, the clitoris has about twice as many nerve endings as the penis. Perhaps that's because the clitoris has more surface area. In addition, circumcision desensitizes the penis to some degree. So, in principle, intercourse is even more stimulating for women than men.

   c. From what I've read, a woman's libido peaks with ovulation, so it's cyclical in a way that man's libido is not.

9. Many women view themselves as missionaries whose role in life is to save a man from his weaknesses. So you might have Christian women who are willing to marry a homosexual convert to Christianity.

10. What about matching up lesbian converts to Christianity with male homosexual converts?

11. As we know, both biblically and historically there have been lots of marriages primarily for pragmatic reasons, not romantic love. Not to mention this still occurs in many contemporary cultures like in Asia.

    Take arranged marriages. Many if not most of these marriages seem to have worked out well enough. They may not reach the ideal of romantic love, but then again I don't know that they haven't either.

    For example, I know close relatives who had an arranged marriage. They started out not knowing one another well, and not romantically loving one another, but after marriage they fell in love.

    I also think of someone like C.S. Lewis originally marrying Joy Davidman not because he loved her but because he felt he needed to help her and her children stay in the UK, and getting married would grant them British residency and citizenship. But he later fell deeply in love with her.

12. Our own society and culture often caricatures arranged marriages as loveless and imprisoning and so forth. I don't doubt this does occur. But isn't this an extreme rather than the norm?

    On the flipside, more traditional cultures seem to me to be quite shocked by how easily Western cultures fall in and out of love, how promiscuous they are, how easily people get divorced, and so forth.

13. We can group normal sexual function in terms of vascular, neurological, hormonal, and psychological systems. Ideally, the initiation and maintenance of penile erection is mainly vascular (the penis becomes engorged with blood), triggered by neurological signals (including visual) on the background of normal hormonal and psychological factors.

14. We can broadly categorize sexual problems in at least three stages:

    a. Sexual desire (e.g. low libido)

    b. Sexual arousal (e.g. erectile dysfunction, failure of arousal in women)

    c. Orgasm (e.g. premature ejaculation, retarded ejaculation, female orgasmic disorder)

15. Many homosexual men and women come with tremendous psychosocial baggage (e.g. poor parental behavior to model or imprint, child neglect, emotional abuse, sexual abuse, physical abuse, depression, suicidal ideation).

    Sadly, many Christians (heterosexuals and penitent homosexuals) may find such scars left unhealed in this life.

    Point being, when it comes to sexuality including sexual intercourse in both men and women, it's not all just hormones and neurophysiology. There's a tremendous psychogenic aspect to sexuality too. I think it's quite possible a normal marriage could actually bring psychological and emotional healing, which in turn could in fact beneficially influence sexual desire, sexual arousal, and orgasm.

16. It's possible to be sexually aroused even if sexual desire isn't initially present. For instance, take wives who may have a "headache" or otherwise not feel in the mood for sexual intercourse, but regardless they decide to have sex with their husbands, and find the stimulation of genitalia can lead to sexual arousal.

    (Another example, though an utterly horrific one, is some women who are raped actually become sexually aroused.)

    Also, this often helps wives bond with their husbands. Sometimes women become sexually aroused in the course of intercourse. But even if they aren't sexually aroused or anything at all (which is I guess one reason vaginal lubricants are so popular on the market), at least they can bond with their husbands in other ways like psychologically and emotionally. And this in turn is sort of like a positive feedback loop which can be helpful in improving sexual desire and arousal and other patterns in the future.

17. Similarly, castrated men can still experience sexual desire.

18. I haven't ever looked into hormone levels in homosexual men (e.g. testosterone). But given that hormone levels can affect sexual behavior, I wonder if homosexual men have significantly lower or higher hormone levels than heterosexual men (e.g. testosterone, estrogen), and if so how this would affect their sexual behavior? There's presumably medication to better balance their hormonal levels.

19. This isn't directly relevant per se, but it might be useful to compare differences between men and women's orgasms (though the differences aren't set in stone and there's some debate over each):

    a. Women can have repeated orgasms separated by very short intervals. There's a much longer refractory period for men.

    b. Women can have an expanded or full body orgasm. Some men may be able to achieve this as well, but it seems much more prevalent among women.

    c. Women's orgasms can last much longer than a man's orgasm. Not just like a few seconds, but 30-60 seconds or even much longer.

    d. Normally, women's orgasms can be stopped mid-orgasm, as it were, whereas normally once a man's orgasm starts it can't be stopped.

20. I've heard the nerve endings in the clitoris are bundled much more closely together than the nerve endings in the penis. But I haven't verified it in the medical literature.

    It's also important to note the course or path of the nerves in men vs. women. There are some interesting differences in how men vs. women are stimulated and how this sensation travels along the nervous system, but I think it'd take a while to write about it. For example, in men and women sexual arousal is due to the part of our nervous system known as the parasympathetic nervous system ("rest and digest" response), but for men ejaculation is due to the sympathetic nervous system ("fight or flight" response), which if I recall isn't the case in the female orgasm (although I should double check). Another example is how the female orgasm (due in large part to activity in the nervous system) leads to rhythmic contractions of the perineal muscles as well as the uterus, which obviously men don't have, and thus can't experience this particular sensation.

    Apart from the nervous system, it's important to note the blood supply to the penis and clitoris. For instance, I wouldn't be surprised to find the clitoris has more blood vessels supplying it than the penis has blood vessels supplying it.

    And there's the significant influence of hormones in sexual intercourse that's different in men vs. women (e.g. oxytocin).

21. We also know that in the past, when homosexuality carried a social stigma, some homosexual men led double lives. Married a woman and fathered kids. So they were able to achieve sexual arousal despite their lack of physical attraction for the opposite sex.

22. The conventional evangelical assumption is that a homosexual convert should first acquire normal attraction for women before he considers marriage.

    But what if, in his case, acquiring normal attraction for women is a result of marriage? Is that the best "reparative" therapy?

    Can he become reoriented in a vacuum, or is marriage his best hope?

23. It seems to me if we look at elderly couples most men are still pretty happily married even though after the years their spouse is no longer physically attractive to them (e.g. gained weight, has gone through disease resulting in physical changes like say a single or double mastectomy). Not to suggest in any way spouses should neglect the physical at all, but it's possible over time couples are attracted to their spouses less for physical reasons and more for other qualities. Most presumably have a healthy sex life.

24. As for women, there seem to be plenty of heterosexual women who have a happy marriage but can't achieve orgasm regularly and some extremely rarely if not never. Here are some stats:

    Sexual complaints are reported by approximately 40 percent of women worldwide [1, 31-33]. This was demonstrated in a study conducted in 29 countries among almost 14,000 women aged 40 to 80 years responding to a questionnaire in person or on the telephone [33]. The most commonly reported types of dysfunction were low sexual desire (26 to 43 percent) and inability to reach orgasm (18 to 41 percent). For all categories of sexual problems, prevalence was highest in Southeast Asia (Indonesia, Malaysia, Philippines, Singapore, and Thailand) and lowest in Northern Europe (Austria, Belgium, Germany, Sweden, and the United Kingdom).

    Most studies have not assessed whether sexual issues are associated with personal distress, a key requirement for diagnosis of female sexual dysfunction. In addition, some studies still exclude women who are not in sexual relationships, so that women for whom sexual dysfunction is a barrier to forming sexual relationships are not assessed [34].

    The largest United States study of female sexual dysfunction, Prevalence of Female Sexual Problems Associated with Distress and Determinants of Treatment Seeking (PRESIDE), did measure personal distress and included women who were not currently in a sexual relationship; over 30,000 women responded to validated questionnaires regarding low desire, low arousal, and orgasm difficulties [1]. The prevalence of any of these three sexual problems (with or without distress) was 43 percent; 22 percent reported sexually related personal distress and 12 percent attributed distress to a specific type of sexual problem (eg, desire).

    Low desire was the most common sexual problem in women, reported by 39 percent of women and associated with distress in 10 to 14 percent [1]. Low arousal (26 percent) and orgasm difficulties (21 percent) were slightly less prevalent, and were both associated with distress in 5 percent of women [1]. Five percent of women reported both low desire and another sexual problem; 2 percent reported all three problems.

    References
    [1] Shifren JL, Monz BU, Russo PA, et al. Sexual problems and distress in United States women: prevalence and correlates. Obstet Gynecol 2008; 112:970.
    [31] Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999; 281:537.
    [32] Fugl-Meyer KS, Arrhult H, Pharmanson H, et al. A Swedish telephone help-line for sexual problems: a 5-year survey. J Sex Med 2004; 1:278.
    [33] Laumann EO, Nicolosi A, Glasser DB, et al. Sexual problems among women and men aged 40-80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors. Int J Impot Res 2005; 17:39.
    [34] Bhasin S, Enzlin P, Coviello A, Basson R. Sexual dysfunction in men and women with endocrine disorders. Lancet 2007; 369:597.

    It's difficult to tell what number of heterosexual women regularly achieve orgasm. But from these stats we can at least say a not insignificant number of heterosexual women do have difficulties with low sexual desire, low arousal, and orgasm.

    That said, it seems there are many women in happy marriages who have good and regular sex with their husbands that say they enjoy sex even though they themselves don't necessarily reach orgasm during sex. Instead, they say they enjoy sex for other reasons like the physical and emotional intimacy, it makes them happy when they please their partners, etc.

    Female sexuality is very complex and it seems to me much more so than male sexuality.

25. Although some Christians would disapprove, the aforementioned might be a good reason for teenage girls to experiment with auto-stimulation. They'd learn two valuable lessons: what an orgasm feels like, and how to trigger it.

    When they marry, that would help them to instruct their husbands in how to better induce an orgasm in the wife. That would obviously benefit the wife. Physically speaking, she'd get as much out of intercourse as the husband.

    And it would make her more enthusiastic about conjugal relations.

26. Similarly, although this might be similarly controversial and I'm not entirely sure I stand on this either, it might be helpful for some married couples to mutually masturbate one another prior to or perhaps temporarily in lieu of sexual intercourse in order to help improve their sexual life in the future. The wife can show her husband what's pleasurable to her, guide him, etc., and vice versa.

Candid med student thoughts on depression and drugs

I posted the following over on Dan Phillips' post:

Hi Dan,

Thanks for your post. I'd like to make some comments please.

1. Since I think it's relevant, I'll start by saying I'm a Christian (Reformed) med student.

2. It sounds like one of the main things you're arguing against is chemical imbalance theories for depression. Arguing against or at least highly suspect of the idea that depression is caused by low levels of serotonin in the brain. I agree there are problems with chemical imbalance theories including the serotonin one. But I don't think this means we should throw out the baby with the bath water.

3. You mention: "I talked to my doctor about the very serious depression I was beginning to experience some decades ago, he told me about the lack of serotonin in my brain, and wanted me to take a pill for it." Obviously a lot has changed in medicine in "decades." Also, we don't know if he was a psychiatrist.

4. Could I humbly suggest you might be burning a strawman, at least in the following respects?

a. To my knowledge and in my experience, many if not most physicians are quite aware our understanding of depression is incomplete. I think the article and video you cite are indicative of this.

b. Many if not most physicians are aware of various theories for depression including low serotonin levels. But again to my knowledge and in my experience I don't know a single contemporary physician who believes low serotonin levels are the be-all and end-all to explaining depression. Many if not most seem to think there could be a number of factors involved.

Take modern psychiatrists. They consider various models including the "bio-socio-psycho-spiritual" model. They'll try to figure out if the person's condition could be due in part or entirely to biological factors (e.g. hypothyroidism, genetic conditions). Also they'll try to see if there are social factors in the person's life to consider (e.g. stressful job, abusive relationships, financial trouble). They'll ask if there are psychological factors involved (e.g. suicidal ideation). And they'll query a person's religious or related beliefs. They're trained to consider the whole person.

c. Indeed, there's quite a bit of debate among psychiatrists over the American Psychiatric Association's recently published DSM-V including over criteria for clinical depression.

d. I don't think it's true, but say it's true most physicians subscribe to the serotonin theory. Nevertheless I would think many if not most understand there's a tremendous difference between correlation and causation.

e. Related, I seriously doubt most physicians would say "mental issues, emotional issues, behavioral issues" are "cut and dried." In fact, we're explicitly taught in med school and explicitly told by doctors in the various hospitals and wards we're required to rotate through that mental issues are anything but. We're explicitly told how mental issues are so difficult and complex to pin down, how ill-defined they are, etc. Indeed, this is one reason why most med students don't wish to go into fields like psychiatry and neurology, because these fields are regarded as less "cut and dried" than other fields in medicine, and most med students seem to tend to prefer fields where there are more concrete diagnoses, treatments, and the like.

5. I could be mistaken, but I suspect to the extent people think "the lack of serotonin" in one's brain is what causes depression is more something large swathes of the media has perpetuated than what doctors today generally subscribe to. For instance there are some studies which have shown selective serotonin reuptake inhibitors (SSRIs) have been successful in treating depression in HIV positive patients. The media could easily take this to indicate serotonin deficiencies cause depression. But physicians know this doesn't mean we should therefore extrapolate from these studies to say SSRIs always work for treating all depressed patients. After all, there could be many other reasons why SSRIs worked in these HIV positive patients which can't be applied to other sorts of patients.

6. A lot hinges on what we mean by depression. For what it's worth, psychiatrists generally classify depression into at least four groups:

a. Adjustment disorder with depressed mood. Depression occurring in reaction to an identifiable stressor or adverse life situation (e.g. death of a loved one, divorce, financial crisis).

b. Mood disorders secondary to illness and medications. Depression as a result of conditions like arthritis, stroke, alcoholism, drugs, etc.

c. Bipolar disorders. There are two subcategories here: mania and cyclothymic disorders. A manic episode is a mood change characterized by elation with hyperactivity, flights of ideas, distractibility, little need for sleep, among others, which swings into depression, anger, aggressiveness, and so forth. Cyclothymic disorders are chronic mood disturbances with episodes of depression and hypomania.

d. Depressive disorders. There are three subcategories here: dysthymia; premenstrual dysphoric disorder; and major depressive disorder. Dysthymia is chronic depressive disturbance generally milder but longer lasting than major depressive disorder. Premenstrual dysphoric disorder is depression as a result of the menstrual cycle. Finally, major depressive disorder has three further divisions: major depression with atypical features; seasonal affective disorder; and postpartum depression.

For example, take postpartum depression. It seems uncontroversial to say hormonal changes and psychosocial stressors in the life of a woman who has recently given birth play large roles in postpartum depression. So this sort of depression would have an arguably strong connection to the physiological (hormonal changes). A doctor might try to treat her postpartum depression with non-pharmacological methods (e.g. psychotherapies), but I don't see that there's anything askew about considering hormonal treatment to better regulate her hormones as part of the arsenal.

7. Regarding medical "tests."

a. Tests can be used for different purposes. For example, there's a difference between using a test for screening and using it for diagnosis.

b. Tests have their limitations. Some tests are more (or less) accurate at finding what they're supposed to find than other tests. Just Google sensitivity and specificity of tests for starters.

c. Tests are only able to find what they're designed to find. Nothing less, nothing more. A chest x-ray is useful for identifying pneumonia, but not useful in identifying brain cancer. An EKG is useful for identifying electrical abnormalities in the heart, but not useful in identifying kidney disease.

d. Some diseases or conditions don't need tests to be diagnosed. It doesn't take a test to diagnose that someone has been stabbed if someone presents with, say, a bleeding wound and says he got into a fight and has been stabbed. A test could be used to see where the knife punctured or where to operate. But it'd be superfluous to order a test to confirm they've been stabbed.

Or to take a more mundane example, physicians don't really need to order a test to diagnose the common cold. It can be done based on the patient's history and/or a quick physical examination. Their signs and symptoms usually say it all.

e. As for depression. The diagnosis of a depressive episode includes determining the psychiatric category and determining if the etiology is idiopathic or related to an underlying systemic or neurologic condition, substance use, or prescription medication side effect.

f. The diagnosis of depression is largely based on patient history and mental status examination. Also, there's usually an evaluation for suicide risk. And a patient history would normally include a comprehensive medical history, exploration of comorbid psychiatric disorders like substance use, and of course a family history.

g. There's no evidence to support routine laboratory testing in the diagnosis of depression. However, a complete blood count, a basic chemistry profile, liver function tests, TSH, RPR, B12, and folate levels are helpful when underlying medical conditions are suspected.

8. I would think most people don't directly see a psychiatrist. Rather I would think most people are probably referred to a psychiatrist by another physician. Generally speaking, a referral to a psychiatrist most likely means the referring physician thinks the person's illness would be best suited for a psychiatrist to treat or manage. This in turn could quite possibly mean a physician has already tried to address non-psychiatric aspects of the person's illness. In short, psychiatrists are generally consulted primarily for psychiatric and related concerns, not for non-psychiatric concerns.

9. Richard Winter over at Covenant Seminary seems to be a good Christian psychiatrist.

The End of Infidelity

Hot off the presses! Check out The End of Infidelity.

By the way, Triablogue has a new eBooks section on their right hand sidebar.

"Reflections on the Church in Great Britain"

Unless he was aiming for a British sense of sarcasm, it appears Mark Driscoll recently took the British to task for their lack of celebrity pastors: "Let's just say this: right now, name for me the one young, good Bible teacher that is known across Great Britain. You don't have one – that's the problem. There are a bunch of cowards who aren't telling the truth."

On the plus side, I guess Northern Ireland pastors are aite in Driscoll's book.

Anyway, D.A. Carson responds (with a good measure of wit, to boot) to his good friend in a post titled "Reflections on the Church in Great Britain."

While we're on the topic, Carson's article "Observations of a Friend" (1995) on the Anglican Communion is likewise helpful to read. Although it should be noted there have been significant developments within Anglicanism since the article was published (e.g. GAFCON, St. John's Vancouver aka J.I. Packer's church leaving the Anglican Church of Canada).

It should also be said there are several fine British pastors and teachers in the United States. I'm thinking of men like Alistair Begg, Sinclair Ferguson, Liam Goligher, Mark Johnston, Robert Norris, Derek Thomas, and Carl Trueman. By the way, one of my favorite 9Marks interviews features Norris.

A poker tell

From Carl Trueman:

I see Mark Driscoll has had a go at my old country. Well, not really. Only foreigners really talk of 'Brits.' Those of us from the UK never think of ourselves in those terms: we are English, Welsh, Scottish or Irish, especially during the Six Nations. To have a go at the old country, you have to be a bit more specific, I am afraid.

I am surprised at the offence his comments have apparently caused. I cannot speak for the Celts, but the English take a certain pleasure in being hated and rubbished by everyone else. The nation -- like the man -- who has no enemies has, after all, no honour. Nevertheless, there is one quotation which is worth noting:

"Let's just say this: right now, name for me the one young, good Bible teacher that is known across Great Britain. You don't have one - that's the problem."

Notice the three important elements of this sentence: the definite article, 'young' and 'known across Britain.' The Great Man, youth and fame: not high on the list of Paul's priorities; and three basic elements of celebrity culture.

A bit of a poker tell, is it not?

The best is yet to come

End of the year video update from John Piper