Each verse of the American national anthem closes with ¡°the land of the free and the home of the brave¡±. These words seemed increasingly apt as I read this book. A distinguished academic paediatrician and public educator, Paul Offit has previously written on vaccines, autism and alternative medicine. He is pro-vaccination and considers alternative medicine to be without foundation. Here he tackles faith healing, mostly in the context of US religious sects that eschew medical care for prayer, but he also takes a tilt at the Catholic Church and its stance on abortion. It is a disturbing window on to a very different way of negotiating the world, in which accepting medical help is a sin.

Offit must be commended for the detachment and gentleness with which he treats his subjects, who comprise both the faith healers and the parents of children who have died because they failed to receive life-saving medical procedures. Although he is clearly greatly saddened by the suffering of children denied insulin injections, blood transfusions or antibiotics, he keeps his anger at bay. To be angry, to condemn religion as ¡°illogical and potentially harmful¡±, he says, would be to fall into what he sees as a trap set by authors such as Richard Dawkins, Sam Harris and the late Christopher Hitchens. He treads a careful path through exposing the wretchedness caused by religion, while not simply applauding secularism as the remedy.

In trying to counter the literalism and flawed interpretations of the Bible used to make a case against medical treatment, Offit considers changing attitudes towards children and the power of faith healers such as Mary Baker Eddy, founder of the Christian Scientists. He asks carefully if faith healing is a cult. The bulk of the book, however, is one long argument. He cites case after case in which the freedoms of the American republic, including the freedom from restriction on religious practices, have had appalling results. In many states, if worshippers define proxies for medical care such as prayer or exorcism rituals as religious practices, they cannot be held responsible for child abuse or manslaughter. Nor, without special powers granted via the judiciary, can parents be obliged to have their children treated by orthodox medicine. While adults may make their own choices, Offit argues, withholding proven medical procedures from children should be made unacceptable.

In his diary-like narrative of the measles epidemic of 1989-91, centred on the Faith Tabernacle Congregation in Philadelphia, Offit describes how court orders brought medics into the homes of children sick with measles and allowed their hospitalisation. The death rate was particularly high because the tabernacle¡¯s pastor, Charles Reinert, even prohibited the administering of intravenous fluids for dehydration or oxygen for pneumonia. Needless to say, Reinert didn¡¯t permit vaccination either. I was particularly disturbed to read the words of Robert Ross, then Philadelphia¡¯s health commissioner, detailing the large families (birth control was impermissible) and the numbers of physically and mentally disabled children (the effects of non-medically supervised home births) he encountered.

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So much for the free. Ross may be among the brave, but the epithet belongs particularly to Rita Swan, a Christian Scientist whose story Offit recounts. After Swan¡¯s child died of bacterial meningitis, she kept her faith in God but now campaigns with Children¡¯s Healthcare is a Legal Duty (CHILD) so that others will not suffer through ignorance as she and her family did. She and Offit share the same goal.

Helen Bynum formerly lectured in medical history at the University of Liverpool.

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Bad Faith: When Religious Belief Undermines Modern Medicine
By Paul A. Offit
Basic Books, 272pp, ?18.99
ISBN 9780465082964 and 040612 (e-book)
Published 7 May 2015