If people who believe that pressing the anus of a pigeon on the navel of a jaundiced patient "releases the poison" into the bird and cures the sick person, what should a physician trained in evidence-based medicine do? Prof. Avinoam Reches, a senior neurologist at Hadassah University Medical Center in Jerusalem's Ein Kerem and head of the Israel Medical Association's ethics bureau has just published an official position paper advising doctors what to do when faith and clinical treatment clash. In an article just published in the IMA professional journal, Zman Harefuah, Reches writes that he has encountered numerous religious Jews who insist that using seven pigeons in this way and then breaking their necks cause the severely jaundiced patient to recover. However, there is no scientific basis for this "treatment." "The ability of medicine to help and cure is not foolproof, and doctors are well aware of their limitations, but the majority of the general public are not ready to accept this," Reches wrote. "Thus it is common, especially in cases of mortal danger, for patients and their families to seek help outside the medical establishment. A doctor may find himself facing medical advice from clergymen or 'healers' that runs counter to his professional know-how or his worldview." The Patients' Law passed about a decade ago and the principle of the patient's autonomous rights over his body "give him the freedom to choose treatments among the various possibilities, within traditional medicine and outside it," Reches continues. This choice may frequently conflict with the doctor's autonomy, even though this term has never been defined by law. Thus, the IMA position paper states that doctors should allow patients and their families to use services based on their beliefs or religion, but the physician cannot be forced to supply them himself. "There may be cases in which such 'treatments' counter his professional knowledge; in such cases, the doctor may refuse to be involved but allow them to occur on condition that they do not harm the patient, the medical staff or other patients and do not come at the expense of medical resources needed for other patients." Reches concludes that it is best to integrate conventional medicine and faith healing, if demanded, without causing a clash between the two or interfering with the patient's medical care.