ELIEVERS WHO JOIN THE FELLOWSHIP of the Seventh-day Adventist Church pledge their agreement with certain fundamental beliefs, including this statement: "Since alcoholic beverages, tobacco, and the irresponsible use of drugs and narcotics are harmful to our bodies, we are to abstain from them as well."¹

Naturally enough, drunkenness, tobacco use, marijuana smoking, and cocaine sniffing are uncommon among members in good and regular standing. Yet Seventh-day Adventists do have a "drug problem," one I see evidence of almost every day as a physician who treats many Adventist patients. The real Adventist "drug problem" is the confusion shared by many Adventists about drugs, and particularly how to apply Ellen White's counsels about their use.

Updating the Understanding
Adventist pastors and Bible teachers have done a good job through the decades in helping us to understand the importance of following divinely given principles, both in identifying biblical truth and in the applications of truth we make to our daily lives. A favorite Adventist Bible passage illustrating this is the one in which Jesus defends Himself against the charge of law-breaking: "Think not that I am come to destroy the law, or the prophets: I am not come to destroy, but to fulfil. For verily I say unto you, Till heaven and earth pass, one jot or one tittle shall in no wise pass from the law, till all be fulfilled."²

Against those who had devised new meanings for the ancient words, Jesus asserted the principles that undergirded God's law. The sayings and writings of the Torah had become stuck in time: they were "wordbound," so that many people remembered what the sacred writings said, but few people remembered what they actually meant.

Jesus updated the people's understanding of Moses while assuring them that He was not destroying the law or the authority of the prophets. In fact, He was fulfilling or restoring their original meaning-applying the principles behind the words. He was refreshing the prophetic words that the people remembered but didn't fully understand.

As I've listened to many sincere Adventists talk about their uncertainty and confusion regarding the use of medicinal drugs, I've become persuaded that we may be in a similar situation regarding our understanding of the inspired counsel given for our time. Is it possible that we remember what Ellen White said about "drugs" but that we no longer understand why she said it?

What the Prophet Said
If you've studied the Spirit of Prophecy, you've probably read lines like these, written by Ellen White after her 1863 vision about the need for health reform among God's people:

"I was shown that more deaths have been caused by drug-taking than from all other causes combined."³

"Drugs never cure disease. They only change the form and location. Nature alone is the effectual restorer, and how much better could she perform her task if left to herself."⁴

"I tell you this because I dare not withhold it. Christ paid too much for man's redemption to have his body so ruthlessly treated as it has been by drug medication."⁵

As a physician, I've read counsels like these addressed to doctors:

"Drug medication is to be discarded. On this point the conscience of the physician must ever be kept tender and true and clean."⁶

"Drug medication should be worked away from as fast as possible, until entirely discarded."⁷

"The physician who depends upon drug medication in his practice shows that he does not understand the delicate machinery of the human organism."⁸

My Personal Experience
As an Adventist medical student determined to keep my conscience "tender and true and clean," I adopted the 1863 Adventist preference for treatments that were natural, simple, plant-based, wholesome, and drug-free. I also adopted the 1863 Adventist distrust of things that were chemical, synthetic, manufactured, and sold in drugstores.

As I continued to study and became more experienced as a physician, however, I found that I now had a different "drug problem." My "drug-free" approach to medicine would put me in jail if I applied it to the care of my patients! Those 1863 statements, as they read, are no longer "true" in 2002, even though the principles behind them certainly are. More to the point, the "herbal" and alternative treatments preferred by many Adventists aren't "clean," and the state medical boards established to protect patients from unqualified practitioners wouldn't be "tender" toward me if I ignored the proven benefit such drugs as penicillin, insulin, lidocaine, digitalis, and coumadin in treating my patients-even my Adventist ones.

Should I pull my Adventist robes around me and say, "O God, I thank you that I am not like other physicians, using drugs and technology and science, but instead I choose complex herbs whose actions I don't understand and harmless placebos of minor benefit while I struggle to ignore the facts?"

Questions of Consistency
Adventist patients also have to ask themselves about what the counsels given by Ellen White mean for their own care.

If you have appendicitis, will you have surgery without anesthetic chemicals or narcotics for pain control after your operation?

When you have prostate or breast cancer, will you treat it with hot fomentations and herbal teas?

If your child is wasting away with diabetes, will you avoid the synthetic insulins in favor of less pure but more "natural" beef or pork insulins? Or will you just hope and pray over your child's condition? If you do, you may very well join me, under the charge of being unfit parents, in that prison cell reserved for quack practitioners!

More and more Adventists are resolving this dilemma in an unfortunate way-by ignoring the Spirit of Prophecy. Embarrassed by what they perceive to be the gap between Ellen White's counsel and modern science, they back away into a quiet distrust of other aspects of her ministry to the remnant as well. Other Adventist patients consent to use medicinal drugs, but do so poorly, taking them for too short a time, in insufficient doses. Still others express great anxiety about possible side effects, perhaps feeling vaguely guilty about using "drugs" at all, and trying to minimize exposure to them.

Herbs and Alternative Therapies
A sizable number of Adventists resolve the tension by maximizing their exposure to "alternative therapies." They take handfuls of herbs or chemicals or hormones (like SAM-e, glucosamine, chondroitin, MSM) as long as these are sold by a health food store (therefore deemed "natural") and not provided by prescription. Some cheerfully submit to unproved "chelating" therapies and consult naturopaths, reflexologists, acupuncturists, and herbalists. Others consume quantities of vitamins in unphysiologic doses, not realizing that the definition of drug is "any substance that affects the physical or mental functioning of a living organism," a definition that covers all substances in the health food store as well as the drugstore.

Opium, heroin, marijuana, tobacco, coffee, and beer are all "natural," "herbal," "plant-based" substances no Adventist should be consuming. Thousands of plants are natural poisons. Those who believe that "It's herbal, so it can't hurt me" may not always live to see the error of their ways.⁹

But being a faithful, Spirit of Prophecy-respecting Adventist shouldn't mean having to put reason on hold or denying the validity of science, statistics, and experimentation. Trust in the mysterious, untested, and testimonial-based therapies is not what Ellen White was advocating when she recommended "trust in divine power."¹⁰

The World of Ellen White
Contemporary Adventists certainly need to know what Ellen White wrote about health care in the 1860s, but even more important, they need to know why she wrote it to understand the enduring principles it contains.

Just 16 days after the General Conference of Seventh-day Adventists was organized in Battle Creek, Michigan, on May 21, 1863, Ellen White received a pivotal vision about health while visiting in Otswego, Michigan. God clearly had a message of health and healing for the newly organized Seventh-day Adventist Church, and that divine instruction dramatically shaped the future course of the young church.

The first expression of this vision-inspired "health message" occurred in the 1864 publication of Spiritual Gifts, volume 4.¹¹ A long chapter titled simply "Health" appeared in that volume and was accompanied by a shorter chapter, "Experience," in which Ellen White detailed her own family's adjustments to health reform in the months since receiving the vision.

"Health" stressed the importance of a nonflesh diet; urged obedience to "natural law" (physiology); counseled avoidance of intoxicating beverages, tobacco, tea, and coffee; recommended two meals a day for most sedentary workers; advocated fresh air and sunlight in the home; and suggested that houses be built on high ground away from the swamps to avoid "fever and ague" (cardinal symptoms of malaria--a common disease of then unknown cause in the United States at that time).

Also included in "Health" were strong warnings against "poisonous preparations in the vegetable and mineral kingdoms"¹² used by "physicians' administering drugs for unknown diseases"¹³ More ominously, she added that "more deaths have been caused by drug-taking than from all other causes combined. If there was in the land one physician in the place of thousands, a vast amount of premature mortality would be prevented. Multitudes of physicians, and multitudes of drugs, have cursed the inhabitants of the earth, and have carried thousands and tens of thousands to untimely graves."¹⁴

Why did Ellen White write that? Was it really true then? More to the point, what does it mean for medical treatment now?

Medical Diagnosis and Treatment in the 1860s
In the 1860s the existence of bacteria (the "germ theory") was just being confirmed. In 1857 French scientist Louis Pasteur presented his germ theory of fermentation. In 1861, Ignaz Semmelweis published his observations on "childbed fever," concluding that the disease that annually took the lives of hundreds of women was caused by physicians who did not wash their hands between obstetrical examinations. But it wasn't until 1865 that these ideas were first applied to surgery by Joseph Lister in Scotland, using carbolic acid to kill "germs" before an operation.¹⁵

More on the 1860's The Science & Practice of Medicine

While American physicians in the early 1860s knew what malaria, tuberculosis, pneumonia, diabetes, boils, rheumatic fever, tonsillitis, and insanity looked like, they had few if any clues as to the cause of these illnesses, many of them infections, and others stemming from failure of body organs. Their treatments were therefore entirely "empiric"-meaning by trial and error. No reliable studies existed that surveyed either the safety or the effectiveness of the chemicals and herbs they threw at the diseases they encountered. Dependent on their own experiences with patients or on testimonials provided by drug manufacturers or other physicians, they were working in a fog that modern medicine would find unthinkable. Patients given certain chemicals might seem to improve, but no one, doctor or patient, could say with any certainty whether it was because of the drug or in spite of it!

What "Drugs" Were Used in the 1860s?
Most drug therapies in that era were based on the idea that "purging the system" was a good thing: most of the drugs used were felt to be helpful if they caused diarrhea or vomiting. The herbal "nux vomica"¹⁶ was widely used for many conditions because it caused the patient to vomit. This supposedly "cleansed the system." We know this drug today by the name "strychnine," a potent and lethal poison.

I own a copy of a standard American medical textbook called The Science and Practice of Medicine, published in 1868.¹⁷ The textbook lists descriptions of many diseases that you would recognize today, but with strange and dangerous treatments recommended for those illnesses.

Look at Chart 1 to see the 1868 description of the disease and the recommended cure. In almost every case, the drugs advised are either narcotics or toxic chemicals now banned or restricted from human exposure by the Environmental Protection Agency!

The antipoison drug message given through Ellen White was a great blessing for nineteenth-century Seventh-day Adventists, many of whom might have expected to live no longer than the national average of approximately 40 years had they not accepted her counsel. Adventists who stopped the use of tobacco, alcohol, caffeine, strychnine, opium, mercury, arsenic, and the irrational use of digitalis or quinine, and replaced these with a vegetarian diet, a limited sugar intake, rest, sunlight, water treatments, and a few simple, harmless, safe herbs, undoubtedly increased both the length and quality of their lives.

But the Adventist health message was also part of a worldwide, nonsectarian reform movement that soon grew to provide worldwide benefits. The seeds of health-care reform had been scattered broadly in American culture, and both the medical profession and governmental regulation of drugs made slow and steady changes for the better.

God Uses Governmental Regulations
As early as 1880 a food and drug law was proposed in the United States Senate, but powerful industrial lobbies prevented it from being passed till 1906.¹⁸ This law required purity in drugs. It prohibited adulterated or misbranded drugs from being used in interstate commerce, but didn't address the issues of the safety or efficacy of the drugs.

It wasn't until 1938 that the next Food, Drug, and Cosmetic Act required that a drug had to be tested for safety before it could be sold. The act required evidence that the drug did not kill people or shorten their lives before it was brought onto the market, but still did not require testing that a drug worked as claimed.

Finally, in 1962, the Kefauver-Harris amendments required proof of efficacy before a drug could be sold. This standard (that a drug was pure, safe, and worked as claimed) wasn't applied to over-the-counter drugs such as aspirin and Tylenol until 1972, and not completely implemented until 1981, 117 years after Ellen White proclaimed the drugs of her day as poisons to be avoided.

Since 1962 any drug brought to the U.S. market has had to be exhaustively tested to show that it is pure, safe, and effective before it can be sold. This is an expensive process and is done under careful scientific scrutiny. Even so, some drugs have been found to have side effects not known before they are marketed. Each drug also undergoes postmarketing surveillance in which side effects and complications are recorded and studied. Drugs, even those that work, are removed from the market when serious side effects are found.

What About Prescription Drug Side Effects?
There are, of course, legitimate concerns about prescription drugs-as well as about nonprescription drugs, herbal drugs, spices and flavoring agents, and even some foods. Some persons experience multiple-chemical sensitivity and can get sick from medicines that the rest of us have no trouble with.¹⁹

The common side effects of prescription drugs are usually well known (information is almost always included with the medication), and you can read what percent of people taking a drug will have side effects such as "nausea," "headache," "vertigo," or "rashes." The percentage of side effects varies from less than 1 percent to as high as 15 percent or more for some side effects, such as drowsiness. What this means is that for every 100 people taking this medicine, 1 or 15, respectively, will have a symptom. This also means that 85 to 99 of them will not have that symptom, but feel quite fine. Most of the time most of those taking the medication will have an excellent chance of not having any side effects.

Some powerful drugs necessary for severe illnesses such as lupus, rheumatoid arthritis, or cancers require frequent blood testing to prevent serious side effects. But even these drugs, used under direction of a competent physician, hold enormous benefit for those who might otherwise lose their life or exist in crippling misery.

Overusage of antibiotics is presently a hot topic in the news, and there may be validity in not using antibiotics for purely viral illness.²⁰ If an infection gets better or improves on its own within five to seven days, a patient possibly doesn't need an antibiotic. But herbal "antibiotics" and "immune system stimulators" are rarely helpful. Most such products are just placebos, and a few of them have as many side effects as prescription medications, contrary to the claims of their promoters.

Wrestling With the Meaning
Uncomfortable as the thought may be to many sincere Adventists who have intentionally avoided prescription medications in the belief that they were thereby honoring the counsel of the Spirit of Prophecy, we have to conclude that Ellen White simply wasn't talking about the prescription drugs now available for medical treatment when she described the "poisonous drugs" of her era. The "drugs" that she regularly-and appropriately-condemned are in almost all cases poisons no longer medically used or narcotics now used only for severe pain control.

Knowing the historical information, though, doesn't always alleviate our misgivings. Modern medicine has conclusively shown us that the common mental illness called "depression" is often a genetic condition with a chemical basis. But many loyal church members still worry about taking pharmaceutical-grade treatment (Prozac, Zoloft, Effexor, Paxil, Celexa). If they or a loved one suffers from depression, they prefer an herbal antidepressant, especially if it has a nice religious-sounding name, like "St.-John's-wort."

Many with chronic allergies that progress to an infection such as sinusitis, tonsillitis, or bronchitis prefer to treat it with some sort of "natural," "herbal" drug such, such as echinacea or tea-tree oil instead of a prescription antibiotic. When these remedies prove unhelpful, and it becomes necessary to get a prescription such as amoxicillin, tetracycline, cephalexin, or levofloxacin because the sinusitis has turned into a pneumonia, many do so with a sense of failure. They blame themselves ("I got a chill," "I ate too much sugar") instead of blaming the germs Satan has put into the bio-sphere.

Others, tragically, who battle cancer sometimes feel this may be the result of being "slack" about health reform and decide to fight cancer with a stricter vegetarian diet, or with herbal drugs such as essiac tea, or with megavitamin supplements. Some "alternative" practitioners will suggest drinking unphysiologic amounts of water (more than eight glasses a day) in an attempt to drown cancer. Other such practitioners urge believers to reject studied, evidence-based chemotherapy, radiation, or surgical treatments, hoping that God will bless this rejection of science and reward their sincerity and simplicity with healing.

The Claims of Alternative Medicines
A bias against prescription drugs is reinforced when we see infomercials by marketers or manufacturers of "herbal" or "nutritional" substances. These promotional programs repeat horror stories of the medical side effects from prescription medications while proposing that they offer a "more wholesome, natural, safer" way of treatment. They use testimonials to support undocumented claims, or report that they too have "clinical studies" (although the "studies" rarely meet scientific validity). The common denominator in all these efforts is the attempt to sell you some product, often at a considerable cost that seems justified by extravagant claims.

Some practitioners whose professions haven't followed the osteopathic and medical professions in submitting their practice to scientific scrutiny often suggest that their methods, while not as scientific, are more natural, more spiritual, or more wholistic. Although the Spirit of Prophecy directed the church to train qualified medical doctors,²¹ some members feel that even non-Adventist naturopaths or herbalists are more in harmony with the counsel of Ellen White than Loma Linda University-trained Adventist physicians and our church-related hospitals.

The fact that alternative medicine has been enormously profitable is not the most important argument against claims made by some of its practitioners. Orthodox health care is big business too, and prescription drugs are sometimes very expensive.

A more realistic-and balanced- approach would be to consider any use of medicinal drugs with a clear insistence on both good science and good faith. When prescription medications have been tested for purity, safety, and efficacy, they may do a world of good, curing diseases and significantly increasing the length and quality of life. For Adventists who believe that we have a mission to share the love and story of Jesus with "every nation, and kindred, and tongue, and people,"²² the benefits of improved health and longer life for the sake of mission are considerable.

Equally important, understanding the context and actual meaning of the inspired counsel that helped to shape this movement may remove old prejudices against helpful medicines, and result in happier, healthier Christians who can make use of all the healing gifts God has given to His children.

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¹ Seventh-day Adventist Fundamental Belief No. 21, "Christian Behavior." You can read all 27 online at: www.adventist.org/beliefs/index.html.
² Matt. 5:17, 18.
³ Ellen G. White, Spiritual Gifts (1864), vol. 4, p. 133.
⁴ Ibid., p. 134.
⁵ White, Medical Ministry, p. 229.
⁶ Ibid., p. 227.
⁷ White, Counsels on Diet and Foods, p. 406.
⁸ White, Selected Messages, book 2, p. 284.
⁹ Varro E. Tyler, Ph.D., former dean of the Purdue University School of Pharmacy (author of The Honest Herbal and Herbs of Choice), writes: "Particularly insidious is the myth that there is something almost magical about herbal drugs that prevents them, in their natural state, from harming people."
¹⁰ White, The Ministry of Healing, p. 127.
¹¹ White, Spiritual Gifts, vol. 4, pp. 120-154.
¹² Ibid., p. 140.
¹³ Ibid., p. 135.
¹⁴ Ibid., p. 133.
¹⁵ The common mouthwash Listerine is named in his honor!
¹⁶ "Nux Vomica-the strychnine containing seed, used in medicine, of the orangelike fruit borne by an East Indian tree Strychnos nux-vomica, in the family Loganiaceae" (New Webster's Dictionary).
¹⁷ William Aitken, The Science and Practice of Medicine (Philadelphia: Lindsay and Blakiston, 1868).
¹⁸ The United States Food and Drug Administration has a good public Web site with information on the history of FDA legislation: www.fda.gov/oc/history/.
¹⁹ Some of these unfortunate "chemically sensitive" people turn out to have a genetic defect called porphyria. Common chemicals benign to the rest of us make them very ill.
²⁰ Many illnesses are symbiotic with the viral illness, paving the way for bacteria to act up too. What begins as a simple viral cold can end up as bacterial sinusitis. In cases such as this, antibiotics may be necessary for what began as a "simple cold."
²¹ Arthur White, Ellen G. White: The Later Elmshaven Years, vol. 6, pp. 297-299.
²² Rev. 14:6.

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Dr. John B. Hoehn is a family physician in Walla Walla, Washington. A lifelong Adventist, he received all his formal education in Adventist schools and served with his wife, Deanne, for 12 years as a medical missionary in Lesotho and Zambia.