Simvastatin, marketed under the trade nameZocor among others, is a lipid-lowering medication. It is used along with exercise, diet, and weight loss to decrease elevated lipid levels. It is also used to decrease the risk of heart problems in those at high risk. It is taken by mouth.
Common side effects include constipation, headaches, and nausea. Serious side effects may include muscle breakdown, liver problems, and increased blood sugar levels. A lower dose may be needed in people with kidney problems. There is evidence of harm to the developing baby when taken during pregnancy and it should not be used by those who are breastfeeding. It is in the statin class of medications and works by decreasing the manufacture of cholesterol by the liver.
Simvastatin was patented by Merck in 1980, and came into medical use in 1992. It is on the World Health Organization's List of Essential Medicines. It is available as a generic medication and at a relatively low cost. Simvastatin is made from the fungus Aspergillus terreus. In 2017, it was the eighth most commonly prescribed medication in the United States, with more than 56 million prescriptions.
Medical uses
The primary uses of simvastatin are to treat dyslipidemia and to prevent atherosclerosis-related complications such as stroke and heart attacks in those who are at high risk. It is recommended to be used as an addition to a low-cholesterol diet.
In the Scandinavian Simvastatin Survival Study
(a placebo-controlled, randomized clinical trial of five years'
duration), simvastatin reduced overall mortality in people with existing
cardiovascular disease and high LDL cholesterol by 30% and reduced
cardiovascular mortality by 42%.
The risks of heart attack, stroke, or needing a coronary
revascularization procedure were reduced by 37%, 28%, and 37%,
respectively.
The Heart Protection Study
evaluated the effects of simvastatin in people with risk factors
including existing cardiovascular disease, diabetes, or stroke, but
having relatively low LDL cholesterol. In this trial, which lasted 5.4
years, overall mortality was reduced by 13% and cardiovascular mortality
was reduced by 18%. People receiving simvastatin experienced 38% fewer
nonfatal heart attacks and 25% fewer strokes.
Simvastatin has been used to explore whether statins have an effect on delaying on the onset and progression of age-related macular degeneration (AMD).
Results from one trial showed participants assigned to simvastatin had
lower odds (0.51 OR) of having AMD progression at three years compared
to those assigned to placebo, though the results were not significant. Overall, evidence is insufficient to conclude that simvastatin has an effect in delaying the onset and progression of AMD.
Contraindications
Simvastatin is contraindicated with pregnancy, breastfeeding, and liver disease.
Pregnancy must be avoided while on simvastatin due to potentially
severe birth defects. Patients cannot breastfeed while on simvastatin
due to potentially disrupting the infant's lipid metabolism. High doses of simvastatin are also contraindicated with the widely used antihypertensive amlodipine. A lower dose is also recommended in people taking the calcium channel blockers, verapamil and diltiazem, as well as those taking amiodarone.
Adverse effects
Common
side effects (>1% incidence) may include indigestion and eczema.
Rare side effects include joint pain, memory loss, and muscle cramps.
Cholestatic hepatitis, hepatic cirrhosis, rhabdomyolysis (destruction
of muscles and blockade of renal system), and myositis have been
reported in patients receiving the drug chronically. Serious allergic reactions to simvastatin are rare.
If the following signs of a serious allergic reaction occur, seek
medical attention immediately: rash, hoarseness itching/swelling,
dizziness, or difficulty swallowing/breathing.
A type of DNA variant known as a single nucleotide polymorphism (SNP) may help predict individuals prone to developing myopathy when taking simvastatin; a study ultimately including 32,000 patients concluded the carriers of one or two risk alleles of a particular SNP, rs4149056, were at a five-fold or 16-fold increased risk, respectively.
In 2012, the Clinical Pharmacogenetics Implementation Consortium has
released guidelines regarding the use of rs4149056 genotype in guiding
dosing of simvastatin and updated the guideline in 2014.
In March 2012, the U.S. Food and Drug Administration
(FDA) updated its guidance for statin users to address reports of
memory loss, liver damage, increased blood sugar, development of type 2 diabetes, and muscle injury. The new guidance indicates:
FDA has found that liver injury associated with statin use is rare but can occur.
The reports about memory loss, forgetfulness, and confusion span all
statin products and all age groups. The FDA says these experiences are
rare, but that those affected often report feeling "fuzzy" or unfocused
in their thinking.
A small increased risk of raised blood sugar levels and the
development of type 2 diabetes have been reported with the use of
statins.
Some drugs interact with statins in a way that increases the risk of
muscle injury called myopathy, characterized by unexplained muscle
weakness or pain.
On 19 March 2010, the FDA issued another statement regarding
simvastatin, saying it increases the risk of muscle injury (myopathy)
when taken at high doses or at lower doses in combination with other
drugs.
The highest dose rate causes muscle damage in 610 of every 10,000
people in contrast to a lower dose, which causes muscle damage in eight
of 10,000 people.
The FDA warning, released again on 8 June 2011, suggested that
high-dose "simvastatin should be used only in patients who have been
taking this dose for 12 months or more without evidence of muscle
injury" and that it "should not be started in new patients, including
patients already taking lower doses of the drug."
Interactions
Simvastatin has important interactions with grapefruit
juice and other drugs, including some that are commonly used for the
treatment of cardiovascular disease. These interactions are clinically
important because increasing simvastatin serum levels above those
normally provided by the maximum recommended dose increases the risk of
muscle damage, including the otherwise rare and potentially fatal side
effect of rhabdomyolysis.
Consuming large amounts of grapefruit juice increases serum
levels of simvastatin by up to three-fold, increasing the risk of side
effects. The FDA recommends that people taking statins should avoid consuming more than a quart (946 ml) of grapefruit juice per day.
All statins act by inhibiting 3-hydroxy-3-methylglutaryl (HMG) coenzyme A reductase. HMG-CoA reductase, the rate-limitingenzyme of the HMG-CoA reductase pathway, the metabolic pathway responsible for the endogenous production of cholesterol. Statins are more effective than other lipid-regulating drugs at lowering LDL-cholesterol concentration, but they are less effective than the fibrates
in reducing triglyceride concentration. However, statins reduce
cardiovascular disease events and total mortality irrespective of the
initial cholesterol concentration. This is a major piece of evidence
that statins work in another way than the lowering of cholesterol
(called pleiotropic effects).
The drug is in the form of an inactive lactone that is hydrolyzed after ingestion to produce the active agent. It is a white, nonhygroscopic, crystalline powder that is practically insoluble in water, and freely soluble in chloroform, methanol, and ethanol.
Simvastatin is an effective serum lipid-lowering drug that can decrease low density lipoprotein (LDL) levels by up to 50%. Simvastatin had been shown to interact with lipid-lowering transcription factor PPAR-alpha and that interaction might control the neurotrophic action of the drug.
History
The development of simvastatin was closely linked with lovastatin. Biochemist Jesse Huff and his colleagues at Merck began researching the biosynthesis of cholesterol in the early 1950s.[35] In 1956, mevalonic acid was isolated from a yeast extract by Karl Folkers,
Carl Hoffman, and others at Merck, while Huff and his associates
confirmed that mevalonic acid was an intermediate in cholesterol
biosynthesis. In 1959, the HMG-CoA reductase enzyme (a major contributor of internal cholesterol production) was discovered by researchers at the Max Planck Institute. This discovery encouraged scientists worldwide to find an effective inhibitor of this enzyme.
By 1976, Akira Endo had isolated the first inhibitor, mevastatin, from the fungusPenicillium citrinium while working at Daiichi Sankyo in Japan. In 1979, Hoffman and colleagues isolated lovastatin from a strain of the fungus Aspergillus terreus.
While developing and researching lovastatin, Merck scientists
synthetically derived a more potent HMG-CoA reductase inhibitor from a
fermentation product of A. terreus, which was designated MK-733 (later to be named simvastatin).
In 1994, publication of the results of the Scandinavian Simvastatin Survival Study
(4S) provided the first unequivocal evidence that lowering LDL
cholesterol via statin treatment reduces cardiovascular events and
overall mortality. A total of 4,444 people with coronary heart disease
5.5 to 8.0 mmol/L were randomized to simvastatin treatment or placebo
and followed for an average of 5 years. Compared to the placebo group,
those treated with simvastatin experienced a 30% decrease in overall
mortality, a 42% reduction in coronary death, a 34% reduction in major
coronary events, and a 37% reduction in revascularization procedures.
Society and culture
Cost
Simvastatin is relatively inexpensive. The wholesale cost in some LMIC is around US$0.01 to 0.15 per 20 mg dose as of 2014. The defined daily dose is 30 mg per the World Health Organization. The price decreased from roughly US$1,200 to $40 per year of medication in LMIC following the patent expiring in 2006. In the United States, it costs about US$10 to 20 per month since patent protection ended. In the UK in 2008, the typical per-patient cost to the NHS of simvastatin was about £1.50 per month. (40 mg/day costs UK NHS £1.37/month in 2012) The price in Canada is about $CAD 130 to 160 per year as of 2016. Under provisions of the Patient Protection and Affordable Care Act (PPACA) in the United States, there is no cost for simvastatin 10 mg, 20 mg, and 40 mg for adults aged 40–75 years based on United States Preventive Services Task Force (USPSTF) recommendations.
Economics
Simvastatin was introduced in the late 1980s, and since 2006 in many countries, it is available as a generic
preparation. This has led to a decrease of the price of most statin
drugs, and a reappraisal of the health economics of preventive statin
treatment.
Prior to losing U.S. patent protection, simvastatin was Merck
& Co.'s largest-selling drug and second-largest selling
cholesterol-lowering drug in the world. In 2005, recorded US$3.1 billion of sales in the United States and US$4.4 billion worldwide.
Zocor had an original patent expiry date of 24 December 2005 but was extended by the United States Patent and Trademark Office (USPTO) to expire on 23 June 2006.
The USPTO granted the patent extension after Merck submitted data from
studies of the drug's positive effect on children. In the UK, the patent
for simvastatin had expired by 2004.
In the UK, simvastatin was the most prescribed medication in the
community in 2013, with 39.9 million items dispensed. This compares to
30.9 million items for aspirin, and 27.7 million for levothyroxine sodium, the second- and third-most prescribed drugs in the UK in 2013.
Marketing
Simvastatin was initially marketed by Merck & Co
under the trade name Zocor but is available generically in most
countries following the patent expiry. A combination of simvastatin
along with ezetimibe is sold under the brand name Vytorin and is jointly marketed by Merck and Schering-Plough.
Brand names include Zocor, Zocor Heart Pro, marketed by the pharmaceutical company
Merck & Co., Simlup, Simvotin, Simcard [India], Denan (Germany),
Liponorm, Sinvacor, Sivastin (Italy), Lipovas (Japan), Lodales (France),
Zocord (Austria and Sweden), Zimstat, Simvahexal (Australia), Lipex
(Australia and New Zealand), Simvastatin-Teva, Simvacor, Simvaxon,
Simovil (Israel), available in Thailand under the brand Bestatin
manufactured by Berlin Pharmaceutical Industry Co Ltd and others.
The U.S. patent for Zocor expired on 23 June 2006. Ranbaxy Laboratories (at the 80-mg strength) and Teva Pharmaceutical Industries
through its Ivax Pharmaceuticals unit (at all other strengths) were
given approval by the FDA to manufacture and sell simvastatin as a generic drug with 180-day exclusivity. Dr. Reddy's Laboratories also has a license from Merck & Co. to sell simvastatin as an authorized generic drug.
Fenofibrate, sold under the brand name Tricor among others, is a medication of the fibrate class used to treat abnormal blood lipid levels. It is less preferred to statin medications as it does not appear to reduce the risk of heart disease or death. Its use is recommended together with dietary changes. It is taken by mouth.
It was patented in 1969, and came into medical use in 1975. It is available as a generic medication. In 2017, it was the 70th most commonly prescribed medication in the United States with more than eleven million prescriptions.
Medical uses
Fenofibrate is mainly used for primary hypercholesterolemia or mixed dyslipidemia. Fenofibrate appears to decrease the risk of cardiovascular disease and possibly diabetic retinopathy in those with diabetes mellitus,
and firstly indicated for the reduction in the progression of diabetic
retinopathy in patients with type 2 diabetes and existing diabetic
retinopathy in Australia. It also appears to be helpful in decreasing amputations of the lower legs in this same group of people. Fenofibrate also has an off-label use as an added therapy of high blood uric acid levels in people who have gout.
It is used in addition to diet for treatment of adults with severe
hypertriglyceridemia. Improving glycemic control in diabetics showing
fasting chylomicronemia will usually decrease the need for pharmacologic
intervention.
Statins remain the first line for treatment of blood cholesterol.
AHA guidelines from 2013 did not find evidence for routine use of
additional medications.
Additionally, in 2016, the FDA filed "Withdrawal of Approval of
Indications Related to the Coadministration With Statins in Applications
for Niacin Extended-Release Tablets and Fenofibric Acid Delayed Release
Capsules" noting "the Agency has concluded that the totality of the
scientific evidence no longer supports the conclusion that a
drug-induced reduction in triglyceride levels and/or increase in HDL
cholesterol levels in statin-treated patients results in a reduction in
the risk of cardiovascular events. Consistent with this conclusion, FDA
has determined that the benefits of niacin ER tablets and fenofibric
acid DR capsules for coadministration with statins no longer outweigh
the risks, and the approvals for this indication should be withdrawn."
Contraindications
Fenofibrate is contraindicated in:
Patients with severe renal impairment,
including those receiving dialysis (2.7-fold increase in exposure, and
increased accumulation during chronic dosing in patients with estimated glomerular filtration rate < 30 mL/min)
When
fenofibrate and a statin are given as combination therapy, it is
recommended that fenofibrate be given in the morning and the statin at
night, so that the peak dosages do not overlap.
Can increase cholesterol excretion into the bile, leading to risk of cholelithiasis; if suspected, gallbladder studies are indicated. See "Interaction" section under Bile acid sequestrant
Coagulation/Bleeding
Exercise caution in concomitant treatment with oral Coumadin anticoagulants (e.g. warfarin). Adjust the dosage of Coumadin to maintain the prothrombin time/INR at desired level to prevent bleeding complications.
Overdose
"There
is no specific treatment for overdose with fenofibric acid
delayed-release capsules. General supportive care is indicated,
including monitoring of vital signs and observation of clinical status". Additionally, hemodialysis
should not be considered as an overdose treatment option because
fenofibrate heavily binds to plasma proteins and does not dialyze well.
Interactions
These drug interactions with fenofibrate are considered major and may need therapy modifications:
Bile acid sequestrants (e.g. cholestyramine, colestipol,
etc.): If taken together, bile acid resins may bind to fenofibrate,
resulting in a decrease in fenofibrate absorption. To maximize
absorption, patients need to separate administration by at least 1 h
before or 4 h to 6 h after taking the bile acid sequestrant.
Immunosuppressants (e.g. ciclosporin or tacrolimus):
An increased risk of renal dysfunction exists with concomitant use of
immunosuppressants and fenofibrate. Approach with caution when
coadministering additional medications that decrease renal function
Vitamin K antagonists (e.g. warfarin):
As previously mentioned, fenofibrate interacts with coumadin
anticoagulants to increase the risk of bleeding. Dosage adjustment of
vitamin K antagonist may be necessary.
Statins: Combination of statins and fenofibrate may increase the risk of rhabdomyolysis or myopathy.
Mechanism of action
"In
summary, enhanced catabolism of triglyceride-rich particles and reduced
secretion of VLDL underlie the hypotriglyceridemic effect of fibrates,
whereas their effect on HDL metabolism is associated with changes in HDL
apolipoprotein expression."
Fenofibrate is a fibric acid derivative, a prodrug comprising fenofibric acid linked to an isopropyl ester. It lowers lipid levels by activating peroxisome proliferator-activated receptor alpha (PPARα). PPARα activates lipoprotein lipase and reduces apoprotein CIII, which increases lipolysis and elimination of triglyceride-rich particles from plasma.
PPARα also increases apoproteins AI and AII, reduces VLDL- and
LDL-containing apoprotein B, and increases HDL-containing apoprotein AI
and AII.
Formulations
Fenofibrate is available in several formulations and is sold under several brand names, including Tricor by AbbVie, Lipofen by Kowa Pharmaceuticals America Inc, Lofibra by Teva, Lipanthyl, Lipidil, Lipantil micro and Supralip by Abbott Laboratories,
Fenocor-67 by Ordain Health Care, Fibractiv 105/35 by Cogentrix Pharma(
India), Fenogal by SMB Laboratories, Antara by Oscient Pharmaceuticals,
Tricheck by Zydus (CND), Atorva TG by Zydus Medica, Golip by GolgiUSA
and Stanlip by Ranbaxy (India). Different formulations may differ in
terms of pharmacokinetic properties, particularly bioavailability; some must be taken with meals, whereas others may be taken without regard to food.
The active form of fenofibrate, fenofibric acid, is also available in the United States, sold as Trilipix. Fenofibric acid may be taken without regard to the timing of meals.
Controversy
In
the United States, Tricor was reformulated in 2005. This reformulation
is controversial, as it is seen as an attempt to stifle competition from
generic equivalents of the drug, and is the subject of antitrust litigation by generic drug manufacturer Teva. Also available in the United States, Lofibra is available in 54 and 160 mg tablets, as well as 67, 134, and 200;mg micronized capsules.
Generic equivalents of Lofibra capsules are currently available in all
three strengths in the United States. In Europe, it is available in
either coated tablet or capsule; the strength range includes 67, 145,
160 and 200 mg. The differences among strengths are a result of altered bioavailability
(the fraction absorbed by the body) due to particle size. For example,
200 mg can be replaced by 160 mg micronized fenofibrate. The 145 mg
strength is a new strength that appeared in 2005-2006 which also
replaces 200 or 160 mg as the fenofibrate is nanonised (i.e. the
particle size is below 400 nm).
History
Fenofibrate was first synthesized in 1974, as a derivative of clofibrate,
and was launched on the French market shortly thereafter. It was
initially known as procetofen, and was later renamed fenofibrate' to
comply with World Health OrganizationInternational Nonproprietary Name guidelines.
Fenofibrate was developed by Groupe Fournier SA of France, which was acquired in 2005 by Solvay Pharmaceuticals, a business unit of the Belgian corporation Solvay S.A..
In 2009, Solvay was, in turn, acquired by Abbott Laboratories (now
AbbVie in the US and Mylan in Europe, Canada, Australia, New Zealand and
Japan).
Research
COVID-19
In
July 2020, researchers from Israel and the U.S. suggested that
fenofibrate might significantly slow down the replication of the
SARS-CoV-2 virus in lung cells. This hypothesis awaits testing in clinical trials.
American civil religion is a sociological theory that a nonsectarian quasi-religious faith exists within the United States
with sacred symbols drawn from national history. Scholars have
portrayed it as a cohesive force, a common set of values that foster
social and cultural integration. The ritualistic elements of ceremonial deism
found in American ceremonies and presidential invocations of God can be
seen as expressions of the American civil religion. The very heavy
emphasis on pan-Christian religious themes is quite distinctively
American and the theory is designed to explain this.
The concept goes back to the 19th century, but in current form, the theory was developed by sociologist Robert Bellah in 1967 in his article, "Civil Religion in America". The topic soon became the major focus at religious sociology conferences and numerous articles and books were written on the subject. The debate reached its peak with the American Bicentennial celebration in 1976. There is a viewpoint that some Americans have come to see the document of the United States Constitution, along with the Declaration of Independence and the Bill of Rights as cornerstones of a type of civic or civil religion or political religion.
Political sociologist Anthony Squiers argues that these texts act as
the sacred writ of the American civil religion because they are used as
authoritative symbols in what he calls the politics of the sacred. The
politics of the sacred, according to Squiers are "the attempt to define
and dictate what is in accord with the civil religious sacred and what
is not. It is a battle to define what can and cannot be and what should
and should not be tolerated and accepted in the community, based on its
relation to that which is sacred for that community."
According to Bellah, Americans embrace a common "civil religion"
with certain fundamental beliefs, values, holidays, and rituals,
parallel to, or independent of, their chosen religion.
Presidents have often served in central roles in civil religion, and
the nation provides quasi-religious honors to its martyrs—such as Abraham Lincoln and the soldiers killed in the American Civil War. Historians have noted presidential level use of civil religion rhetoric in profoundly moving episodes such as World War II, the Civil Rights Movement, and the September 11th attacks.
In a survey of more than fifty years of American civil religion
scholarship, Squiers identifies fourteen principal tenets of the
American civil religion:
Reverence to certain sacred texts and symbols of the American civil
religion (The Constitution, The Declaration of Independence, the flag,
etc.)
The sanctity of American institutions
The belief in God or a deity
The idea that rights are divinely given
The notion that freedom comes from God through government
Governmental authority comes from God or a higher transcendent authority
The conviction that God can be known through the American experience
God is the supreme judge
God is sovereign
America's prosperity results from God's providence
America is a "city on a hill" or a beacon of hope and righteousness
The principle of sacrificial death and rebirth
America serves a higher purpose than self-interests
In an examination of over fifty years of political discourse, Squiers
finds that filial piety, reference to certain sacred texts and symbols
of the American civil religion, the belief in God or a deity, America is
a "city on a hill" or a beacon of hope and righteousness, and America
serves a higher purpose than self-interests are the most frequently
referenced. He further found that there are no statistically significant
differences in the amount of American civil religious language between
Democrats and Republicans, incumbents and non-incumbents nor
Presidential and Vice-Presidential candidates.
This belief system has historically been used to reject nonconformist ideas and groups.
Theorists such as Bellah hold that American civil religion can perform
the religious functions of integration, legitimation, and prophecy,
while other theorists, such as Richard Fenn, disagree.
Development of concept
Alexis de Tocqueville
believed that Christianity was the source of the basic principles of
liberal democracy, and the only religion capable of maintaining liberty
in a democratic era. He was keenly aware of the mutual hatred between
Christians and liberals in 19th-century France, rooted in the Enlightenment and the French Revolution. In France, Christianity was allied with the Old Regime before 1789 and the reactionary Bourbon Restoration
of 1815-30. However he said Christianity was not antagonistic to
democracy in the United States, where it was a bulwark against dangerous
tendencies toward individualism and materialism, which would lead to atheism and tyranny.
Also important were the contributions of French philosopher Jean-Jacques Rousseau (1712–1778) and French sociologist Émile Durkheim (1858–1917).
The American case
Most students of American civil religion follow the basic Bellah/Durkheimian interpretation. Other sources of this idea include philosopher John Dewey who spoke of "common faith" (1934); sociologist Robin Murphy Williams' American Society: A Sociological Interpretation (1951) which stated there was a "common religion" in America; sociologist Lloyd Warner's analysis of the Memorial Day celebrations in "Yankee City" (1953 [1974]); historian Martin Marty's "religion in general" (1959); theologian Will Herberg who spoke of "the American Way of Life" (1960, 1974); historian Sidney Mead's "religion of the Republic" (1963); and British writer G. K. Chesterton,
who said that the United States was "the only nation ... founded on a
creed" and also coined the phrase "a nation with a soul of a church".
In the same period, several distinguished historians such as Yehoshua Arieli, Daniel Boorstin, and Ralph Gabriel "assessed the religious dimension of 'nationalism', the 'American creed', 'cultural religion' and the 'democratic faith'".
Premier sociologist Seymour Lipset
(1963) referred to "Americanism" and the "American Creed" to
characterize a distinct set of values that Americans hold with a
quasi-religious fervor.
Today, according to social scientist Ronald Wimberley and William
Swatos, there seems to be a firm consensus among social scientists that
there is a part of Americanism that is especially religious in nature,
which may be termed civil religion. But this religious nature is less
significant than the "transcendent universal religion of the nation"
which late eighteenth century French intellectuals such as Jean-Jacques Rousseau and Alexis de Tocqueville wrote about.
Evidence supporting Bellah
Ronald
Wimberley (1976) and other researchers collected large surveys and
factor analytic studies which gave support to Bellah's argument that
civil religion is a distinct cultural phenomenon within American society
which is not embodied in American politics or denominational religion.
Examples of civil religious beliefs are reflected in statements used in the research such as the following:
Later research sought to determine who is civil religious. In a 1978
study by James Christenson and Ronald Wimberley, the researchers found
that a wide cross section of American citizens have civil religious
beliefs. In general though, college graduates and political or religious
liberals appear to be somewhat less civil religious. Protestants and Catholics have the same level of civil religiosity. Religions that were created in the United States, the Latter Day Saints movement, Adventists, and Pentecostals,
have the highest civil religiosity. Jews, Unitarians and those with no
religious preference have the lowest civil religion. Even though there
is variation in the scores, the "great majority" of Americans are found
to share the types of civil religious beliefs which Bellah wrote about.
Further research found that civil religion plays a role in
people's preferences for political candidates and policy positions. In
1980 Ronald Wimberley found that civil religious beliefs were more
important than loyalties to a political party in predicting support for
Nixon over McGovern with a sample of Sunday morning church goers who
were surveyed near the election date and a general group of residents in
the same community. In 1982 James Christenson and Ronald Wimberley
found that civil religion was second only to occupation in predicting a
person's political policy views.
Coleman has argued that civil religion is a widespread theme in
history. He says it typically evolves in three phases:
undifferentiation, state sponsorship in the period of modernization,
differentiation. He supports his argument with comparative historical
data from Japan, Imperial Rome, the Soviet Union, Turkey, France and The
United States.
The elitists who ran the Federalists were conscious of the need to boost voter identification with their party.
Elections remained of central importance but for the rest of the
political year celebrations, parades, festivals, and visual
sensationalism were used. They employed multiple festivities, exciting
parades, and even quasi-religious pilgrimages and "sacred" days that
became incorporated into the American civil religion. George Washington
was always its hero, and after his death he became a sort of demigod looking down from heaven to instill his blessings on the party.
At first the Federalists focused on commemoration of the
ratification of the Constitution; they organized parades to demonstrate
widespread popular support for the new Federalist Party. The parade
organizers, incorporated secular versions of traditional religious
themes and rituals, thereby fostering a highly visible celebration of
the nation's new civil religion.
The Fourth of July became a semi-sacred day—a status it maintains
in the 21st century. Its celebration in Boston proclaimed national
over local patriotism, and included orations, dinners, militia
musters, parades, marching bands, floats and fireworks. By 1800, the
Fourth was closely identified with the Federalist party. Republicans
were annoyed, and stage their own celebrations on the fourth—with rival
parades sometimes clashing with each other. That generated even more
excitement and larger crowds. After the collapse of the Federalists
starting in 1815, the Fourth became a nonpartisan holiday.
President as leader of civil religion
Since
the days of George Washington presidents have assumed one of several
roles in American civil religion, and that role has helped shape the
presidency. Linder argues that:
Throughout American history, the
president has provided the leadership in the public faith. Sometimes he
has functioned primarily as a national prophet, as did Abraham Lincoln.
Occasionally he has served primarily as the nation's pastor, as did
Dwight Eisenhower. At other times he has performed primarily as the high
priest of the civil religion, as did Ronald Reagan. In prophetic civil
religion, the president assesses the nation's actions in relation to
transcendent values and calls upon the people to make sacrifices in
times of crisis and to repent of their corporate sins when their
behavior falls short of the national ideals. As the national pastor, he
provides spiritual inspiration to the people by affirming American core
values and urging them to appropriate those values, and by comforting
them in their afflictions. In the priestly role, the president makes
America itself the ultimate reference point. He leads the citizenry in
affirming and celebrating the nation, and reminds them of the national
mission, while at the same time glorifying and praising his political
flock.
Charles W. Calhoun argues that in the 1880s the speeches of Benjamin Harrison
display a rhetorical style that embraced American civic religion;
indeed, Harrison was one of the credo's most adept presidential
practitioners. Harrison was a leader whose application of Christian
ethics to social and economic matters paved the way for the Social Gospel, the Progressive Movement and a national climate of acceptance regarding government action to resolve social problems.
Linder argues that President Bill Clinton's sense of civil religion was based on his Baptist background in Arkansas. Commentator William Safire
noted of the 1992 presidential campaign that, "Never has the name of
God been so frequently invoked, and never has this or any nation been so
thoroughly and systematically blessed."
Clinton speeches incorporated religious terminology that suggests the
role of pastor rather than prophet or priest. With a universalistic
outlook, he made no sharp distinction between the domestic and the
foreign in presenting his vision of a world community of civil faith.
Brocker argues that Europeans have often mischaracterized the politics of President George W. Bush (2001–2009) as directly inspired by Protestant fundamentalism.
However, in his speeches Bush mostly actually used civil religious
metaphors and images and rarely used language specific to any Christian
denomination. His foreign policy, says Bocker, was based on American security interests and not on any fundamentalist teachings.
Hammer says that in his 2008 campaign speeches candidate Barack Obama
portrays the American nation as a people unified by a shared belief in
the American Creed and sanctified by the symbolism of an American civil
religion.
Would-be presidents likewise contributed to the rhetorical history of civil religion. The speeches of Daniel Webster
were often memorized by student debaters, and his 1830 endorsement of
"Liberty and Union, now and forever, one and inseparable" was iconic.
Symbolism of the American flag
According to Adam Goodheart, the modern meaning of the American flag, and the reverence of many Americans towards it, was forged by Major Robert Anderson's fight in defense of the flag at the Battle of Fort Sumter, which opened the American Civil War
in April 1861. During the war the flag was used throughout the Union to
symbolize American nationalism and rejection of secessionism. Goodheart
explains the flag was transformed into a sacred symbol of patriotism:
Before that day, the flag had
served mostly as a military ensign or a convenient marking of American
territory ... and displayed on special occasions like the Fourth of
July. But in the weeks after Major Anderson's surprising stand, it
became something different. Suddenly the Stars and Stripes flew ... from
houses, from storefronts, from churches; above the village greens and
college quads. ... [T]hat old flag meant something new. The abstraction
of the Union cause was transfigured into a physical thing: strips of
cloth that millions of people would fight for, and many thousands die
for.
Soldiers and veterans
An
important dimension is the role of the soldiers, ready to sacrifice
their lives to preserve the nation. They are memorialized in many
monuments and semi-sacred days, such as Veterans Day and Memorial Day.
Historian Jonathan Ebel argues that the "soldier-savior" is a sort of
Messiah, who embodies the synthesis of civil religion, and the Christian
ideals of sacrifice and redemption.
In Europe, there are numerous cemeteries exclusively for American
soldiers who fought in world wars. They have become American sacred
spaces.
Pacifists have made some sharp criticisms. For example, Kelly Denton-Borhaug, writing from the Moravian peace tradition,
argues that the theme of "sacrifice" has fueled the rise of what she
calls "U.S. war culture." The result is a diversion of attention from
what she considers the militarism and the immoral, oppressive, sometimes
barbaric conduct in the global American war on terror. However, some Protestant denominations such as the Churches of Christ, have largely turned away from pacifism to give greater support to patriotism and civil religion.
Pledge of Allegiance
Kao and Copulsky argue the concept of civil religion illuminates the popular constitutional debate over the Pledge of Allegiance.
The function of the pledge has four aspects: preservationist,
pluralist, priestly, and prophetic. The debate is not between those who
believe in God and those who do not, but it is a dispute on the meaning
and place of civil religion in America.
Cloud explores political oaths since 1787 and traces the tension
between a need for national unity and a desire to affirm religious
faith. He reviews major Supreme Court decisions involving the Pledge of Allegiance, including the contradictory Minersville School District v. Gobitis (1940) and West Virginia v. Barnette
(1943) decisions. He argues that the Pledge was changed in 1954 during
the Cold War to encourage school children to reject communism's
atheistic philosophy by affirming belief in God.
School rituals
Adam Gamoran
(1990) argues that civil religion in public schools can be seen in such
daily rituals as the pledge of allegiance; in holiday observances, with
activities such as music and art; and in the social studies, history
and English curricula. Civil religion in schools plays a dual role: it
socializes youth to a common set of understandings, but it also sets off
subgroups of Americans whose backgrounds or beliefs prevent them from
participating fully in civil religious ceremonies.
Ethnic minorities
The
Bellah argument deals with mainstream beliefs, but other scholars have
looked at minorities outside the mainstream, and typically distrusted or
disparaged by the mainstream, which have developed their own version of
U.S. civil religion.
White Southerners
Wilson, noting the historic centrality of religion in Southern identity, argues that when the White South
was outside the national mainstream in the late 19th century, it
created its own pervasive common civil religion heavy with mythology,
ritual, and organization. Wilson says the "Lost Cause"—that
is, defeat in a holy war—has left some southerners to face guilt,
doubt, and the triumph of what they perceive as evil: in other words, to
form a tragic sense of life.
Black and African Americans
Woodrum and Bell argue that black people demonstrate less civil religiosity than white people
and that different predictors of civil religion operate among black and
white people. For example, conventional religion positively influences
white people's civil religion but negatively influences black peoples'
civil religion. Woodrum and Bell interpret these results as a product of
black American religious ethnogenesis and separatism.
Japanese Americans
Iwamura argues that the pilgrimages made by Japanese Americans to the sites of World War II-era internment camps
have formed a Japanese American version of civil religion. Starting in
1969 the Reverend Sentoku Maeda and Reverend Soichi Wakahiro began
pilgrimages to Manzanar National Historic Site
in California. These pilgrimages included poetry readings, music,
cultural events, a roll call of former internees, and a
nondenominational ceremony with Protestant and Buddhist ministers and Catholic and Shinto
priests. The event is designed to reinforce Japanese American cultural
ties and to ensure that such injustices will never occur again.
Hispanic and Latino Americans
Mexican-American labor leader César Chávez,
by virtue of having holidays, stamps, and other commemorations of his
actions, has practically become a "saint" in American civil religion,
according to León. He was raised in the Catholic tradition and using
Catholic rhetoric. His "sacred acts," his political practices couched in
Christian teachings, became influential to the burgeoning Chicano
movement and strengthened his appeal. By acting on his moral convictions
through nonviolent means, Chávez became sanctified in the national
consciousness, says León.
Christian language, rhetoric, and values helped colonists to perceive
their political system as superior to the corrupt British monarchy.
Ministers' sermons were instrumental in promoting patriotism and in
motivating the colonists to take action against the evils and corruption
of the British government. Together with the semi-religious tone
sometimes adopted by preachers and such leaders as George Washington, and the notion that God favored the patriot cause, this made the documents of the Founding Fathers suitable as almost-sacred texts.
The National Archives Building in Washington preserves and displays the Declaration of Independence, the Constitution and the Bill of Rights. Pauline Maier describes these texts as enshrined in massive, bronze-framed display cases.
While political scientists, sociologists, and legal scholars study the
Constitution and how it is used in American society, on the other hand,
historians are concerned with putting themselves back into a time and
place, in context. It would be anachronistic for them to look at the
documents of the "Charters of Freedom" and see America's modern "civic
religion" because of "how much Americans have transformed very secular
and temporal documents into sacred scriptures".
The whole business of erecting a shrine for the worship of the
Declaration of Independence strikes some academic critics looking from
point of view of the 1776 or 1789 America as "idolatrous, and also
curiously at odds with the values of the Revolution." It was suspicious
of religious iconographic practices. At the beginning, in 1776, it was
not meant to be that at all.
On the 1782 Great Seal of the United States,
the date of the Declaration of Independence and the words under it
signify the beginning of the "new American Era" on earth. Though the
inscription, Novus ordo seclorum, does not translate from the
Latin as "secular", it also does not refer to a new order of heaven. It
is a reference to generations of society in the western hemisphere, the
millions of generations to come.
Even from the vantage point of a new nation only ten to twenty
years after the drafting of the Constitution, the Framers themselves
differed in their assessments of its significance. Washington in his
Farewell Address pleaded that "the Constitution be sacredly
maintained."' He echoed Madison in "Federalist No. 49"
that citizen "veneration" of the Constitution might generate the
intellectual stability needed to maintain even the "wisest and freest
governments" amidst conflicting loyalties. But there is also a rich
tradition of dissent from "Constitution worship". By 1816, Jefferson
could write that "some men look at constitutions with sanctimonious
reverence and deem them like the ark of the covenant,
too sacred to be touched." But he saw imperfections and imagined that
potentially, there could be others, believing as he did that
"institutions must advance also".
While the civil religion has been widely accepted by practically all denominations, one group has always stood against it. Seventh-Day Adventists
deliberately pose as "heretics", so to speak, and refuse to treat
Sundays as special, due to their adherence to the Ten Commandments
dictating that Saturday is the holy day. Indeed, says Bull, the
denomination has defined its identity in contradistinction to precisely
those elements of the host culture that have constituted civil religion.
Making a nation
The American identity has an ideological connection to these "Charters of Freedom". Samuel P. Huntington
discusses common connections for most peoples in nation-states, a
national identity as product of common ethnicity, ancestry and
experience, common language, culture and religion. Levinson argues:
It is the fate of the United
States, however, to be different from "most peoples," for here national
identity is based not on shared Proustian remembrances, but rather on
the willed affirmation of what Huntington refers to as the "American
creed," a set of overt political commitments that includes an emphasis
on individual rights, majority rule, and a constitutional order limiting
governmental power.
The creed, according to Huntington, is made up of (a) individual
rights, (b) majority rule, and (c) a constitutional order of limited
government power. American independence from Britain was not based on
cultural difference, but on the adoption of principles found in the
Declaration. Whittle Johnson in The Yale Review
sees a sort of "covenanting community" of freedom under law, which,
"transcending the 'natural' bonds of race, religion and class, itself
takes on transcendent importance".
Becoming a naturalized citizen of the United States requires
passing a test covering a basic understanding of the Declaration, the
U.S. Constitution, and the Bill of Rights, and taking an oath to support
the U.S. Constitution. Hans Kohn
described the United States Constitution as "unlike any other: it
represents the lifeblood of the American nation, its supreme symbol and
manifestation. It is so intimately welded with the national existence
itself that the two have become inseparable." Indeed, abolishing the
Constitution in Huntington's view would abolish the United States, it
would "destroy the basis of community, eliminating the nation,
[effecting] ... a return to nature."
As if to emphasize the lack of any alternative "faith" to the
American nation, Thomas Grey in his article "The Constitution as
scripture", contrasted those traditional societies with divinely
appointed rulers enjoying heavenly mandates for social cohesion with
that of the United States. He pointed out that Article VI, third clause,
requires all political figures, both federal and state, "be bound by
oath or affirmation to support this Constitution, but no religious test
shall ever be required..." This was a major
break not only with past British practice commingling authority of
state and religion, but also with that of most American states when the
Constitution was written.
Escape clause. Whatever the oversights and evils the
modern reader may see in the original Constitution, the Declaration that
"all men are created equal"—in their rights—informed the Constitution
in such a way that Frederick Douglass in 1860 could label the Constitution, if properly understood, as an antislavery document.
He held that "the constitutionality of slavery can be made out only by
disregarding the plain and common-sense reading to the Constitution
itself. [T]he Constitution will afford slavery no protection when it
shall cease to be administered by slaveholders," a reference to the
Supreme Court majority at the time.
With a change of that majority, there was American precedent for
judicial activism in Constitutional interpretation, including the
Massachusetts Supreme Court, which had ended slavery there in 1783.
Accumulations of Amendments under Article V of the Constitution
and judicial review of Congressional and state law have fundamentally
altered the relationship between U.S. citizens and their governments.
Some scholars refer to the coming of a "second Constitution" with the Thirteenth Amendment, we are all free, the Fourteenth, we are all citizens, the Fifteenth, men vote, and the Nineteenth,
women vote. The Fourteenth Amendment has been interpreted so as to
require States to respect citizen rights in the same way that the
Constitution has required the Federal government to respect them. So
much so, that in 1972, the U.S. Representative from Texas, Barbara Jordan, could affirm, "My faith in the Constitution is whole, it is complete, it is total...".
After discussion of the Article V provision for change in the Constitution as a political stimulus to serious national consensus building, Sanford Levinson
performed a thought experiment which was suggested at the bicentennial
celebration of the Constitution in Philadelphia. If one were to sign the
Constitution today,
whatever our reservations might be, knowing what we do now, and
transported back in time to its original shortcomings, great and small,
"signing the Constitution commits one not to closure but only to a
process of becoming, and to taking responsibility for the political
vision toward which I, joined I hope, with others, strive."
