Balancing Faith and Medicine
An interview with Dr. Joseph Starke
Dr. Joseph Starke is a primary care physician at Mercy Clinic Primary Care in Jackson, Missouri where he focuses on osteopathic medicine (a healthcare approach that treats the whole person: body, mind, and spirit). He earned his undergraduate degree from Saint Louis University in 2009 and went on to graduate from the Lincoln Memorial University DeBusk College of Osteopathic Medicine in 2014. He is a member of the Missouri Association of Osteopathic Physicians and Surgeons. More importantly, Dr. Starke is a Catholic husband and father to four children. The Starkes are parishioners at Immaculate Conception in Jackson.
Can you tell us a bit about yourself and your journey to becoming a doctor specializing in Natural Family Planning?
I remember having a conversation with a coworker when I was working for campus ministry at SLU during my undergrad years. I was explaining to her that when it comes to Church teaching, I always take the Church at her word. It’s up to me, then, to study and pray to understand why the teaching is what it is. She was countering that she would study a theological topic, and would then make a decision from there. If she came to the same conclusion as the Church, that was fine. However, if she came to a different conclusion, then she would take the position that she felt was best. The Church does tell us that when we have a well formed conscience, we have the ability to make a moral decision that is best for the situation we are in at that time. It seems backward to me, though, to start with our own experience, and then substitute that in place of Church teaching. Even if we do have a well formed conscience, is there any way that in our short lives we could have the wisdom and experience of the last 2000 years of the Church?
Think of all the Saints and Christians that came before us and got us to where we are today. The Church has already been through all the same struggles. The heresies that plagued Augustine and Irenaeus are the same ones that we are dealing with today. So how do we just start from our blank slate and expect to form for ourselves what the Church has already done? Work smarter, not harder. Start with the experience of the Church. If we start with personal experience, then there are 7 billion truths in the world. We know that’s not accurate. There’s only one Truth. Start there. Sometimes our experience will line up with it. When it doesn’t, we can meet people where they are and then help them work towards unity with that one Truth. Jesus didn’t meet Mary Magdalene where she was and then tell her to stay there. The disciples didn’t meet Jesus on the road to Emmaus and then continue walking in the same direction they were going the day before.
When it comes to human sexuality, I start not with my experience, but with what the Church teaches. Humanae Vitae and the Theology of the Body. Reading through these, you can see the Truth and Wisdom they contain. I think most people who disagree with these teachings haven't looked at the actual text, or even an accurate summary. Venerable Fulton Sheen said that you can’t find 100 people in the United States who hate the Catholic Church, but you could find millions who hate what they perceive the Catholic Church to be. We could add what they perceive the Catholic Church to teach. I don’t remember exactly the first time I read these documents or heard about them. It’s not like the Church’s teaching is a secret. It's been there my whole life. After reading and praying to seek a better understanding, I couldn’t come up with any reason to think it was wrong. So how could I just ignore that in favor of what a secular-influenced school or medical society or professor would say? Being a “Catholic physician,” therefore, was never an option. It’s just what I was always going to do, and I knew that well before I even started applying to medical school.
“In the matter of reforming things, as distinct from deforming them, there is one plain and simple principle; a principle which will probably be called a paradox. There exists in such a case a certain institution or law; let us say, for the sake of simplicity, a fence or gate erected across a road. The more modern type of reformer goes gaily up to it and says, "I don't see the use of this; let us clear it away." To which the more intelligent type of reformer will do well to answer: "If you don't see the use of it, I certainly won't let you clear it away. Go away and think. Then, when you can come back and tell me that you do see the use of it, I may allow you to destroy it.”
G.K. Chesterton
For those who might be unfamiliar, could you explain what Natural Family Planning is and how it differs from other methods of family planning?
Natural Family Planning (NFP) is a general term for a number of different methods in which a couple can avoid or achieve pregnancy without the use of any man-made interventions. Humanae Vitae states that every sexual act must retain its procreative and unitive aspects. When we introduce artificial methods for avoiding pregnancy (i.e. barriers, birth control pills, injections, implants, IUDs, etc.), or in an attempt to achieve a pregnancy, (i.e. artificial insemination, IVF), then the methods are not considered natural. Artificial methods for avoiding pregnancy also include sterilization, both tubal ligation in women as well as vasectomy in men.
There are multiple types of NFP and each is generally focused on the methods used to track the cycle of the woman. These different indicators may include:
Basal Body Temperature
Cervical mucus monitoring
Symptothermal
Calendar/rhythm
I am a certified Medical Consultant for Creighton Model Fertility Care System (CrMS), which utilizes cervical mucus monitoring.
Obviously, all of these methods are unitive since the couple engages in intercourse to achieve pregnancy. There are going to be occasions in which it is necessary to space births; or avoid pregnancy due to potential serious health effects to the mother or baby. The Church recognizes this and has stated it multiple times, although it is often overlooked. God knows and understands this. It’s in His design.
During the course of a normal cycle, women will have days of fertility and infertility depending on the fluctuation of hormones and time of ovulation. Men do not experience this type of cyclic hormone change and are always considered fertile. When a couple is tracking the woman’s cycle using NFP, they can identify these days and choose to use an infertile day in order to avoid a pregnancy.
Even though the couple is using an infertile day, they are doing so in a natural way, one given by God’s design and Natural Law. Therefore, these acts retain their “intrinsic relationship to the procreation of human life.” Artificial birth control is by definition not intrinsic. It does not naturally occur. When used, it disrupts this relationship between a husband and wife.
From a medical perspective, what are the benefits of Natural Family Planning for couples compared to other forms of contraception?
It appears that more women are starting to speak out about the problems with birth control. Since the introduction of the birth control pill in the 1960s, artificial, hormonal birth control has been a default position for any woman seeking to avoid pregnancy and for most gynecologic issues. I think we’re starting to see now the adverse effects of all that medication. We haven’t so much fixed these problems as substituted them for new symptoms. Those women who were using it solely for birth control went from healthy to living with the adverse effects. All because they thought they had no other options.
The unique aspect of the Creighton Model (CrMS) is that it not only can be used to avoid or achieve pregnancy, but as discovered very early on in the studies to develop this system, it can be used to treat a host of gynecologic issues. The application of CrMS to medical treatment is called Natural Procreative Technology (NaPro).
For example, for women who have polycystic ovary syndrome (PCOS), the first line of treatment is often to put them on a birth control pill. This essentially shuts down the ovaries, and then her PCOS symptoms start to subside. However, that doesn’t fix the underlying problem. Shutting off the system is not a correction. And for women who are trying to conceive, it doesn’t do anything to improve their fertility. Patients with PCOS who are trying to conceive may not be given birth control. They are sometimes given metformin or Clomid to try to help with ovulation, which we also use in CrMS; but they get no progesterone support during the second half of their cycle. This makes it very difficult for them to conceive and then carry a pregnancy in the early weeks. They are then pushed quickly to artificial insemination or IVF. However, as anyone who has experienced or knows someone who has undergone IVF, this is extremely expensive and lacks consistent success. (We can present the reasons for the Church’s stance against IVF elsewhere).
I am thinking now specifically of two PCOS patients who came to our clinic in the past year, concerned about their symptoms and infertility. We used CrMS to correct their PCOS. They started to ovulate regularly, and we supported their progesterone levels in the second half of the cycle. These patients who had been struggling with infertility for years conceived within six months of starting their treatment. It’s a small sample size for me, but CrMS physicians have been seeing this type of success for years
I should note here that CrMS has an 80% success rate for infertility. Compare that to 20% with IVF.
Probably the most common condition we treat is premenstrual syndrome/premenstrual dysphoric disorder (PMS/PMDD). We are starting to see more PCOS and other ovulatory disorders. Based on recent conversations, we’re also expecting an increase in patients seeking treatment for infertility, which can result for a variety of reasons. Gynecologists trained in minimally invasive NaPro surgical techniques treat even more conditions, like endometriosis.
How do you address concerns about effectiveness and reliability that some may have regarding Natural Family Planning?
I think the most common concern for couples considering NFP, whether it be CrMS or another model, is achieving an unintended pregnancy. They feel that they need artificial birth control so they won’t conceive before they are ready.
Most secular statistics that I’ve seen state that NFP in general is only successful in avoiding pregnancy 50–60% of the time. However, these numbers are not telling the whole story. When these statistics are usually reported about NFP, they are for any use. Couples that use the method incorrectly or knowingly use fertile days are still counted in the failure rate.
Birth control pills, for example, are labeled as being 98-99% effective at avoiding pregnancy. However, this is only reported with consistent or perfect use of the medication. If we looked at all the patients who were taking birth control pills and included those who skip doses, the effectiveness would be much lower. For CrMS specifically, couples who are charting correctly and only utilizing infertile days for intercourse also have a reported 98-99% effectiveness at avoiding pregnancy.
During our courses, Dr. Hilgers, the founder of CrMS and NaPro Technology, stated that in patients who needed to avoid pregnancy for serious health issues, he limited their use to only those infertile days after ovulation. Once a woman has reached her peak day, she is fertile for only 3 days. After that, there’s no possibility of pregnancy. So between that time and the start of the next menses, the system is 100% effective at avoiding pregnancy. This can be done through charting; and a progesterone level can be used if extra reassurance is needed.
Some express concern that the charting itself is too difficult. It does take a little time and dedication to learn, and I think the women in our practice would say that it gets easier over time. No different than anything else new in life.
It is obvious that the Church teaches chastity and abstinence are part of single life, but they have a role in married life as well. There will be those times when a couple may have desires but decides to avoid intercourse because they are trying to avoid pregnancy. And that is not a bad thing.
Between 1979 and 1984, John Paul II gave a series of general audience speeches on human sexuality, which when compiled later would become the Theology of the Body. During his catechesis on Matthew 5:27-28 he stated, “Adultery ‘in the heart’ is not committed only because the man ‘looks’ in this way at a woman who is not his wife, but precisely because he looks in this way at a woman. Even if he [a husband] were to look in this way at the woman who is his wife, he would commit the same adultery ‘in the heart.’” This caused quite the controversy. Many scoffed at his statement. How could a man lust after or commit adultery toward his own wife? John Paul goes on to explain that in these situations, even if it is a husband toward his wife, a woman is reduced to an object for the possible satisfaction of a man’s own sexual urge.
So when artificial birth control is present, is a married man prone to lust or adultery toward his own wife when he thinks she is always available to him upon his desire and request? A woman’s natural cycle and discipline of abstinence within marriage can be a way to positively uphold the dignity of both husband and wife.
For Catholic healthcare professionals who may be interested in incorporating Natural Family Planning into their practice, what steps would you recommend they take?
Prayerfully read the Church’s teachings, including Humanae Vitae. Reading through the entirety of Theology of the Body is like trying to read the Bible cover-to-cover. It has to be done a little at a time, not always in order. Read the most popular sections, or those most relevant to your practice. There are many good summaries as well. Speak with physicians and other health professionals who are incorporating Creighton Model or other forms of NFP into their practice.