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FAQ: Prayer and Medicine
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FAQ: Prayer and Medicine
[b]Authors: Hermit (Preamble)
Revision: 1.0B (Full mark-up)
Author’s notes for revision: This message was (with significant editing to put it into FAQ format) originally posted to the mail list of the Church of Virus on 1999-03-11 under the subject "The Myth of medicine, mysticism and magic was - RE: virus: Brave New World"
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Copyright (C) The Church of Virus, 2002. All rights reserved. Unlimited distribution permitted in accordance with the terms of the Full copyright notice below. The appended article is subject to copyright and is provided here for study by the members of the Church of Virus.
The studies claiming health benefits from “prayer” are deeply flawed. There is no reliable evidence that “prayer” changes the prognosis or outcome of cases.
Those interested in the claim that “prayer” improves medical outcomes.
Table of Contents
Author’s notes for revision
Abbreviated Copyright Notice
Table of Contents
Full copyright notice
Appendix I: Religion, spirituality, and medicine
Interest in connecting religion and medicine
Prayer and Medicine
Studies over the past several years and "religiously" reported on the CoV mail list and other forums have reported that people who believe in God, who are religious, who pray, or who hold strong "spiritual" affinities, have lower blood pressure, recover from diseases and surgery faster, have greater longevity, and in general show many indicators of superior general health. In other words, spiritual health equals physical health. The extraordinary claim that people who are “prayed for” is also made by many believers.
While it has been shown that “meditation” and “prayer” have the same effect on brain chemistry as certain psycho-active drugs, for example “Ecstacy”, affecting dopamine take-up, and providing an addictive sensation of relaxation and well-being, this is clearly a well understood physiological effect which has no relation to “spirituality” and is not affected by the particular form of “meditation” or object of “prayer”.
Leaving the foregoing aside, skeptics have responded that any beneficial effects observes as a consequence of “prayer” are most likely due to psychological reasons such as the placebo effect and self-fulfilling prophecies, or social psychological reasons, such as family support and encouragement to take needed medications, lead a healthier life style ("no, no honey, the doctor said you can't have the extra rich Ben and Jerry's ice cream"), etc. A study published in the February 20, 1999 issue of The Lancet (Vol. 353: 664-667) calls all of this into question and challenges the original studies. The Lancet is unfortunately one of those subscriber only and register to access to access anything but abstracts, so the referenced article is attached in accessible form for the members of the CoV. The Lancet is the world’s preeminent peer reviewed medical journal.
In the appended article, “Religion, spirituality, and medicine”, the authors, Richard Sloan, E. Bagiella, and T. Powell, all from Columbia University, present a comprehensive examination of the empirical evidence and ethical issues involved in claims for a religion-medicine connection. The authors begin by noting that 79% of Americans report they believe that spiritual faith can aid recovery, 63% believe physicians should talk to their patients about spiritual faith, 48% want their doctors to pray with them, and 25% reported using prayer as part of their therapy. Nearly 30 U.S. medical schools offer courses on religion, spirituality, and health. Of 296 physicians at a meeting of the American Academy of Family Physicians, 99% said they believe religious beliefs aid healing, and a remarkable 75% reported that they believe that prayer by one person can actually help someone else recover from an illness. But the authors point out a number of methodological problems:
1. Lack of control of intervening variables.
Many of these studies failed to control for such intervening variables as age, sex, education, ethnicity, socioeconomic status, marital status, and degree of religiosity or religious devotion. Furthermore, the studies do not take into account that most religions have sanctions against behaviors injurious to health, such as smoking, alcohol and drug use, excessive promiscuous sexual activity, and diet. The authors noted that when such variables are controlled for in these studies, the formerly significant results drop off to insignificance. In one study, for example, recovery from hip surgery in elderly women failed to control for age. In another study, church attendance and recovery did not take into account the fact that people in poorer health were less likely to attend church, and thus there was a selection bias. In yet another study on lowering blood pressure through prayer and attending religious services, levels of exercise and physical activity were not taken into account.
2. Failure to control for multiple comparisons.
"Many studies on religion and health fail to make an adjustment for the greater likelihood of finding a statistically significant result when conducting multiple statistical tests. For example, one study reported that religious attendance was inversely associated with high concentrations of interleukin-6 in the elderly. However, interleukin-6 was one of eight outcome variables and there was no attempt to control for multiple comparisons." In other words, report the hits, dismiss the misses. In one of the most highly publicized double-blind studies of patients in a coronary-care unit who were prayed for by born-again Christians, 29 outcome variables were measured but on only six did the prayer group show improvement. "However, the six significant outcomes were not independent: the prayer group had fewer cases of newly diagnosed heart failure and of new prescribed diuretics and fewer cases of newly diagnosed pneumonia and of new prescribed antibiotics. There was no control for multiple comparisons, a fact recognized by the author, “Furthermore, how do you prevent the ‘non-prayer’group from being prayed for by friends and family? Since these were real patients in a real CCU in real critical condition, wouldn't their friends and family members pray for them?”
3. Conflicting findings.
In some studies a number of religiosity variables were used but only those with a significant correlation were reported. Meanwhile, other studies using the same religiosity variables found different correlations and, of course, only reported those. “Moreover, when the entire scale was used, the relation between religion and mortality failed to reach significance.”
The authors also point out that most studies did not provide definitions of religious and spiritual variables, nor of outcome variables. “The absence of specific definitions of religious and spiritual activity is an important problem, since many of the studies to which we refer define these activities differently.” Sloan, Bagiella, and Powell conclude: “Even in the best studies, the evidence of an association between religion, spirituality, and health is weak and inconsistent. We believe therefore that it is premature to promote faith and religion as adjunctive medical treatments.”
So, while it is true that there have been studies which claim that hospital patients that “pray”, are “prayed for” or go through any sort of “religious anything”, experience positive psychosomatic effects.", the results should be viewed with deep suspicion. Before reading the appended article, consider the scope of the claims made. That what one person does can affect another is a given. But the religious claim that this always happens, and that the results are predictable and positive. I would suggest that it is only valid to draw conclusions where there is a causal connection. As the appended articles show, causal effect is far from demonstrated. Patients tend to experience positive effects, psychosomatic or not, at hearing that any interest has been shown in them. Having said that, not all psychosomatic effects are positive.
Let us, before examining the research, consider some of the possible claims for a moment, and assess their likelihood:
1 Ann "prays for" Ann and "believes" that this is good for herself. Possible, maybe even probable, psychosomatic effect, unproven.
2 Ann "prays for" Ann and does not "believe" that this is good for herself but thinks it might help and cannot harm. Possible psychosomatic effect, unproven. Probably less of an effect than 1.
3 Ann hears that a group of pagan friends have slaughtered a cock on her behalf (a “religious anything”). Possible psychosomatic effect, unproven. Effect would surely depend on Ann's belief system. She might feel guilty about it and suffer a negative psychosomatic effect? Unproven.
4 Ann hears that a group of pagan friends have sacrificed a human child on her behalf (another “religious anything”). Possible psychosomatic effect? Positive psychosomatic effect? You tell me. I'd suggest this is like 3 only more so. Unproven.
5 Ann hears that a mythical father killed his equally mythical son so that she can get better. Possible psychosomatic effect??? Depends on Ann I guess. Seems highly improbable.
5a Ann believes what she heard in 5. Effect? Other than the fact that she is no longer rational, is likely to make nonesensical posts to newsgroups and maillists, will be more likely to be dishonest and statistically is more likely to end up in jail....
5b Ann hears that the father and son were not myths. They are her neighbor and his son. Weird people, but the father "really loves" her. What is the effect on Ann now?
6 Joe "prays for" Ann and lets her know about it. Ann "believes" that this is good for herself. Possible, maybe even probable, psychosomatic effect, unproven.
7 Joe "prays for" Ann and lets her know about it. Ann does not "believe" that this is good for herself or Joe and gets angry with him. Possible, maybe even probable, psychosomatic effect, unproven. Is anger good for Ann?
8 If Joe "prays for" Ann and Ann does not know about it, then it seems likely that this will not have any effect on Ann positive or negative. No evidence of anything happening here... etc. etc.
From the above, it seems, as in most cases of belief, that we have hypothesis in the absence of evidence and in the face of reason, indeed, as the happening here. Perhaps worse. The following study provides negative evidence, so the proponents of such ideas are to an extent at least, believing despite opposing evidence. Which lands them squarely in the faith-filled (faith-fooled?) category of dishonest researchers whose words (never mind their heads) need to be examined in the light of their bias.
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Appendix I: Religion, spirituality, and medicine
Source: ”Religion, spirituality, and medicine”, The Lancet, Volume 353 Number 9153, p 664-667, 20 February 1999
Authors: R P Sloan, E Bagiella, T Powell
Behavioral Medicine Program, Columbia-Presbyterian Medical Center (R P Sloan PhD, E Bagiella PhD) and Department of Psychiatry, Columbia University (R P Sloan, T Powell MD); New York State Psychiatric Institute (R P Sloan); Division of Biostatistics, School of Public Health, Columbia University (E Bagiella); and Center for the Study of Society and Medicine, Columbia University (T Powell), New York NY 10032, USA
Correspondence to: Dr Richard P Sloan, Columbia University, Box 427, 622 West 168th St, New York 10032 (e-mail firstname.lastname@example.org)
Religion and science share a complex history as well as a complex present. At various times worldwide, medical and spiritual care was dispensed by the same person. At other times, passionate (even violent) conflicts characterized the association between religion and medicine and science. As interest in alternative and complementary medicine has grown, the notion of linking religious and medical interventions has become widely popular, especially in the USA. For many people, religious and spiritual activities provide comfort in the face of illness. However, as US medical schools increasingly offer courses in religion and spirituality1 and as reports continue to indicate interest in this subject among both physicians and the general public, it is essential to examine how, if at all, medicine should address these issues. Here, in a comprehensive, though not systematic, review of the empirical evidence and ethical issues we make an initial attempt at such an examination.
Interest in connecting religion and medicine
In a recent poll of 1000 US adults, 79% of the respondents believed that spiritual faith can help people recover from disease, and 63% believed that physicians should talk to patients about spiritual faith. Recent articles in such US national newspapers as the Atlanta Constitution, Washington Post, Chicago Tribune, and USA Today report that religion can be good for your health. A new magazine, Spirituality and Health, edited by the former editor of Harvard Business Review, has begun publication. Eisenberg and colleagues, in a widely cited article on unconventional therapies, noted that 25% of all respondents reported using prayer as medical therapy. King and Bushwick reported that 48% of hospital inpatients wanted their physicians to pray with them.
Within the medical community, there is also considerable interest.
Meetings sponsored by the US National Institute of Aging, the National Center for Medical Rehabilitation Research, and the Mind/Body Medical Institute, Beth Israel Deaconess Hospital, Boston, have drawn large, enthusiastic audiences.
Nearly 30 US medical schools include in their curricula courses on religion, spirituality, and health. Of 296 physicians surveyed during the October, 1996, meeting of the American Academy of Family Physicians, 99% were convinced that religious beliefs can heal, and 75% believed that prayers of others could promote a patient's recovery. Benson writes that faith in God has a health-promoting effect. Larson and Matthews argue for spiritual and religious interventions in medical practice, hope that the "wall of separation" between medicine and religion will be torn down, and assert that "the medicine of the future is going to be prayer and Prozac" (ref 8, p 85). In an American Medical Association publication, Matthews and colleagues recommend that clinicians ask "what can I do to support your faith or religious commitment?" to patients who respond favorably to questions about whether religion or faith are "helpful in handling your illness'.
In many studies, religion, as a putative antecedent to health outcomes, has been measured in several ways--eg, assessment of religious behaviors, such as frequency of church attendance or prayer; dimensions of religious experience, such as the comfort it may provide; and health differences as a function of differences in religious denomination or degree of religious orthodoxy.
In addition, health outcomes vary considerably—e.g., physical disease outcomes, mental health outcomes, and health behaviors. Here, we consider methodological issues that pertain to studies of physical disease outcomes.
Control for confounding variables and other covariates Confounders such as behavioral and genetic differences and stratification variables such as age, sex, education, ethnicity, socioeconomic status, and health status may have an important role in the association between religion and health. Failure to control for these factors can lead to a biased estimation of this association. Multivariate methods allow estimation of the magnitude of the association between religious variables and health outcomes while controlling for the effects of other variables. However, use of these
methods requires complete presentation of the results--at least the coefficients and corresponding confidence intervals for all the variables in the statistical model. Reports that fail to do this are incomplete and may be misleading.
Attempts to assess the effect of degree of religiousness on health outcomes show this. Increased religious devotion, assessed as service as a Roman Catholic priest, nun, Morman priest, or Trappist or Benedictine monk is associated with reductions in morbidity and mortality. These cases, however, were selected for study precisely because they are inclined to stricter adherence to codes of conduct that proscribe behaviors associated with risk (e.g., smoking, alcohol consumption, sexual activity, psychosocial stress, and in some cases, consumption of meat).
In a series of studies from Israel,[14-16] religiousness, measured as religious orthodoxy, was also shown to confer health benefits. However, one of these was a case-control study, the deficiencies of which are widely known. In another a multivariate model that predicted mortality from coronary heart disease included standard risk factors but omitted religion, and no information on risk-ratio or confidence intervals or even level of statistical significance was provided. Finally, in a study matching secular and religious Kibbutzim according to location, use of the same regional hospital, and members older than 40 years, all-cause mortality was significantly greater among members of the secular Kibbutzim. However, the strategy of matching ensures equivalence of groups only on the matched variables. As a consequence, the groups differed with respect to dietary habits, smoking, blood cholesterol concentrations, and marital status, with the secular group having greater risk, as the authors themselves report. The multivariate analysis of mortality did not control for these factors.
Control for confounding and other covariates also affects studies that report that religious behaviors and experiences influence health outcomes. In some studies with large databases, this problem can be addressed. Both the Alameda County Study and the Tecumseh Community Health Study showed that frequency of attendance at religious services was inversely associated with mortality.[17,18] However, after control for all relevant covariates, this relation held only for women. In another large study, attendance at religious services was associated with increased functional capacity in The elderly but after control for appropriate covariates, this relation held for only 3 of the 7 years in which outcome data were collected. There was no effect on mortality. In a smaller study, religiousness predicted mortality in the elderly poor but only among those in poor health.
In many other studies, inadequate control for important covariates points to significant findings when none may exist. For example, Pressman and colleagues reported that among elderly women after surgical repair of broken hips, religiousness was associated with better ambulation status at discharge. Although the analysis controlled for severity of health condition, it did not control for age, a critical variable when studying functional capacity in the elderly.
In some cases, problems of interpretation arise not so much in the original research but rather in secondary sources. A case in point is a report by Comstock and Partridge, frequently cited as showing a positive association between church attendance and health. However, as Comstock himself later reported, this finding was probably due to failure to control for the important covariate of functional capacity: people with reduced capacity (and poorer health) were less likely to go to church. This latter study is rarely cited. Similarly, Koenig reports that a study by Colantonio and colleagues "found lower rates of stroke in persons who attended religious services at least once per week . . .". However, this was only the case for the univariate analysis and the effect disappeared after covariates such as levels of physical function were added to the analysis. Levin, in a review of a review, reported that 22 of 27 studies of religious attendance and health showed a significant positive relation, despite his own previous assertion that associations between attendance and health are highly questionable because this research is characterized by numerous methodological problems including the failure to adjust for confounders and covariates.
Finally, many studies evaluate differences in health indicators as a function of religious denomination (e.g. [29-31]). However, they are generally conducted precisely because religious groups differ on risk behaviors such as smoking and alcohol consumption or on genetic heritage.
Failure to control for multiple comparisons
Many studies on religion and health fail to make an adjustment for the greater likelihood of finding a statistically significant result when conducting multiple statistical tests. For example, one study reported that religious attendance was inversely associated with high concentrations of interleukin-6 in the elderly. However, interleukin-6 was one of eight outcome variables and there was no attempt to control for multiple comparisons, as the authors themselves reported. In a retrospective study, the associations between frequency of prayer and six items measuring subjective health were examined. Analyses of variance were conducted on each of these six perceptions of health and three revealed effects of frequency of prayer at the 0·05 level of statistical significance. In such studies, adjustments of levels to control for such multiple comparisons would render these findings non-significant.
There are similar problems in the only published randomized clinical trial. In this double-blind study, patients in a coronary-care unit (CCU) were assigned randomly either to standard care or to daily intercessory prayer ministered by three to seven born-again Christians, outcome variables were measured, and on six the prayer group had fewer newly diagnosed ailments. However, the six significant outcomes were not independent: the prayer group had fewer cases of newly diagnosed heart failure and of newly prescribed diuretics and fewer cases of newly diagnosed pneumonia and of newly prescribed antibiotics. There was no control for multiple comparisons, a fact recognized by the author. To address this issue, "multivariant" analysis was conducted but the results were not presented, except for a p value for overall model.
Published work on religion and health lacks consistency, even among well-conducted studies. For example, while Idler and Kasl found some effects of religious attendance on functional capacity in the elderly, measures of "religious involvement", an index of the "private, reflective" aspects of religion, were not associated with any health outcome. Neither church attendance nor religious involvement was associated with lower mortality. However, in two other large studies[17,18] church attendance was associated with lower mortality, but only in women.
Inconsistencies also arise within studies not based on large epidemiological samples. For instance, when each individual item from the scale of religiousness used by Idler and Kasl, was used in another study, "religious
comfort and strength" was significantly associated with lower mortality after cardiac surgery in the elderly even after control for relevant confounders. However, the other items from this scale, including religious attendance, did not predict mortality. Moreover, when the entire scale was used, the relation between religion and mortality failed to reach significance. Byrd reported an advantage in hospital course for the group receiving prayer compared with the control group. However, the groups did not differ in days in the CCU, length of stay in hospital, and number of discharge medications. While total cholesterol concentrations were lower across all age groups for a cohort of Seventh Day Adventists (SDAs) than in age-matched healthy New York City men and women, suggesting a lower risk of coronary heart disease among SDAs, serum triglycerides of the SDA men in the coronary-prone age range (>32 years) were 19% higher than in the controls, which suggests the opposite.
To some degree, lack of consistency is characteristic of an evolving field and may be the product of differences in study design, definitions of religious and spiritual variables, and outcome variables. The absence of specific definitions of religious and spiritual activity is an important problem, since many of the studies to which we refer define these activities differently. Published research would be substantially improved with better definitions of these terms. However, inconsistency in the empirical findings makes it difficult to support recommendations for clinical interventions.
Health professionals, even in these days of consumer advocacy, influence patients by virtue of their medical expertise. When doctors depart from areas of established expertise to promote a non-medical agenda, they abuse their status as professionals. Thus, we question inquiries into a patient's spiritual life in the service of making recommendations that link religious practice with better health outcomes. Is it really appropriate, as Matthews and colleagues recommend, for a physician to ask patients what he or she can do to support their faith or religious commitment?
A second ethical consideration involves the limits of medical intervention. If religious or spiritual factors were shown convincingly to be related to health outcomes, they would join such factors as socioeconomic status and marital status, already well established as significantly associated with health. Although physicians may choose to engage patients in discussions of these matters to understand them better, we would consider it unacceptable for a physician to advise an unmarried patient to marry because the data show that marriage is associated with lower mortality. This is because we generally regard financial and marital matters as private and personal, not the business of medicine, even if they have health implications. There is an important difference between "taking into account" marital, financial, or religious factors and "taking them on" as the objects of interventions.
A third ethical problem concerns the possibility of doing harm. Linking religious activities and better health outcomes can be harmful to patients, who already must confront age-old folk wisdom that illness is due to their own moral failure. Within any individual religion, are the more devout adherents "better" people, more deserving of health than others? If evidence showed health advantages of some religious denominations over others, should physicians be guided by this evidence to counsel conversion? Attempts to link religious and spiritual activities to health are reminiscent of the now discredited research suggesting that different ethnic groups show differing levels of moral probity, intelligence, or other measures of social worth. Since all human beings, devout or profane, ultimately will succumb to illness, we wish to avoid the additional burden of guilt for moral failure to those whose physical health fails before our own. Some practitioners who link faith and medical practice do so appropriately, and in ways that do not depend on utilitarian expectations of better health. For instance, devout health professionals may view their work as an extension of their religious beliefs. Such physicians may or may not choose to share their opinions with patients. However, some patients and doctors may be aware of a common faith. There is no ethical objection to co-worshippers discussing medical issues in the context of a shared faith. Indeed, a thorough understanding of a patient's religious values can be extremely important in discussing critical medical issues, such as care at the end of life. Irrespective of the practitioner's religion, respectful attention must be paid to the impact of religion on the patient's decisions about health care.
An especially poignant example of the devout practitioner who appropriately notes connections between illness, recovery, and prayers of thanks is provided by Prager, in describing a serious illness in his son. Prager does not suggest that his son recovers function because he is faithful, but rather teaches how the faithful may give thanks for recovery. Such connections between faith and health are valuable because they are sensitive to all aspects of the patient's experience; yet in no way depend on spurious claims about scientific data.
Even in the best studies, the evidence of an association between religion, spirituality, and health is weak and inconsistent.
We believe therefore that it is premature to promote faith and religion as adjunctive medical treatments. However, between the extremes of rejecting the idea that religion and faith can bring comfort to some people coping with illness and endorsing the view that physicians should actively promote religious activity among patients lies a vast uncharted territory in which guidelines for appropriate behavior are needed urgently.
Nonetheless, caution is required. There is a temptation to conclude that this matter can be resolved as soon as methodologically sound empirical research becomes available. Even the existence of convincing evidence of a relation between religious activity (however defined) and beneficial health outcomes may not eliminate the ethical concerns that we raise here. Religious pursuits, such as decisions to marry or have children, are qualitatively different from health behaviors such as quitting smoking or eating a low-fat diet, even if they are linked unequivocally to health benefits.
No one can object to respectful support for patients who draw upon religious faith in times of illness. However, until these ethical issues are resolved, suggestions that religious activity will promote health, that illness is the result of insufficient faith, are unwarranted.
We gratefully acknowledge the contributions of the many colleagues and friends who reviewed this manuscript.
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With or without religion, you would have good people doing good things and evil people doing evil things. But for good people to do evil things, that takes religion. - Steven Weinberg, 1999
Prime example of a practically perfect person
Re:FAQ: Prayer and Medicine
« Reply #2 on: 2006-03-31 12:08:34 »
Prayers Fail to Reduce Heart-Surgery Complications, Study Says
Authors: Steven Bodzin in San Francisco at email@example.com.
The largest study of the medical power of prayer found secret prayers on patients' behalf didn't reduce complications in heart surgery and there was a 14 percent higher chance of problems when patients were aware of the prayers.
The research, appearing in the April issue of the American Heart Journal, followed 1,802 patients undergoing coronary bypass surgery at six hospitals. Of those, one-third weren't prayed for, another third were prayed for without their knowledge by three U.S. Christian congregations, and the rest knew they were the subject of prayers by the church members.
The researchers, led by Herbert Benson and Jeffery A. Dusek of Harvard Medical School and Mind/Body Institute, found that people who knew they received intercessory prayers had the highest chance of complications of the three groups, 59 percent. Among patients who didn't know whether they were the subject of secret prayers, complications occurred in 52 percent of those who were prayed for and 51 percent of those who weren't.
The death rates for 30 days after surgery were similar across all the groups, the two-year study showed.
The investigators set rules for the start and length of prayers and gave only the subjects' first names and last initials to the church congregations. Given the study's size, there was a 95 percent chance that knowing one was prayed for increased complications between 2 percent and 28 percent, according to the paper.
The research, conducted between 1998 and 2000, was a joint project of eight medical institutions including the Mayo Clinic in Rochester, Minnesota, and Integris Baptist Medical Center in Oklahoma City. The study had 16 co-authors.
Patients in the three groups had similar religious profiles and most believed family and friends would be praying for them. The researchers didn't attempt to curtail those or the subjects' own prayers.
"With so many individuals receiving prayer from friends and family, as well as personal prayer, it may be impossible to disentangle the effects of study prayer from background prayer,'' co-author Manoj Jain, from Baptist Memorial Hospital in Memphis, Tennessee, said in a statement released by Columbia University Medical Center yesterday.
With or without religion, you would have good people doing good things and evil people doing evil things. But for good people to do evil things, that takes religion. - Steven Weinberg, 1999