virus: Repeat of The Myth of medicine, mysticism and magic was RE: virus

The (The@Hermit.net)
Thu, 10 Jun 1999 09:58:04 -0500

-----Original Message-----
From: owner-virus@lucifer.com [mailto:owner-virus@lucifer.com]On Behalf Of Snow Leopard
Sent: Thursday, June 10, 1999 5:41
To: virus@lucifer.com
Subject: virus: PRISON STATS

Amongst other things, the SnowLeopard borgdom muttered "...studies have shown that hospital patients that pray, are prayed for or go through any sort of religious anything experience positive psychosomatic effects." While it is true that there have been such studies, the results should be viewed with deep suspicion. Below this note, I will repeat a previous post which explains why.

Before reading (or skipping) the replay just think about the Borg's opinion. That what one person does can affect another is a given. But the Borg claims that this always happens, and that the results are positive. I would suggest that it is only valid to draw conclusions where there is a causal connection. Any 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.

Think about these possibilities for a moment.

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. Wierd 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. So it seems that we have an unsupported hypothesis happening here. Maybe not. As I said earlier, the following study provides some negative evidence. So that the proponents of this hypothesis are to an extent believing despite the evidence. Which lands them squarely in the faith-filled (faith-fooled?) category of dishonest researchers whose words (never mind their heads) needs to be examined in the light of their bias.

TheHermit <PS More than 65% of Americans believe that astrology predicts the future accurately. That is not true either, despite all of these peoples' belief and despite all the studies claiming that it can.>

Repeat follows...

I am on a mail list where I received a brief note about this and it looked
interesting, so I pulled the rest from the Lancet site. The Lancet is unfortunately one of those subscriber only and register to access to access
anything but abstracts type sites, so here it is in a more accessible form
for anyone who is interested. The horses mouth as far as peer reviewed current medical opinion re Religion, spirituality, 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. Skeptics have responded that the effect is most likely due to psychological reasons such
as the placebo effect and self-fulling prophecies, or social psychological
reasons, such as familysupport 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
themselves. 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."

TheHermit

>From

http://www.thelancet.com/newlancet/reg/issues/vol353no9153/menu_NOD999.h tml

Volume 353, Number 9153 20 February 1999

Religion, spirituality, and medicine

R P Sloan, E Bagiella, T Powell

Lancet 1999; 353: 664-67



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 rps7@columbia.edu)

Interest in connecting religion and medicine Empirical evidence
Ethical issues
Conclusions
References

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 characterised 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.2 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.3 King and Bushwick4
reported that 48% of hospital inpatients wanted their physicians to pray with them.4

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,5 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.1 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.6 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,7 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 favourably to questions about
whether religion or faith are "helpful in handling your illness'.9

Empirical evidence
In many studies, religion, as a putative antecedent to health outcomes, has
been measured in several ways--eg, assessment of religious behaviours, 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--eg, physical disease outcomes, mental health outcomes, and health behaviours. Here, we consider
methodological issues that pertain to studies of physical disease outcomes.

Control for confounding variables and other covariates Confounders such as behavioural 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,10 nun,11 Morman priest,12, or Trappist or Benedictine monk,13 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 behaviours associated with risk (eg, 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 these14 was a case-control study, the deficiencies of which are widely
known. In another,15 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 behaviours 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
elderly19 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.20 In a smaller study, religiousness predicted mortality
in the elderly poor but only among those in poor health.21

In many other studies, inadequate control for important covariates points to
significant findings when none may exist. For example, Pressman and colleagues22 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,23 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.24 This latter study is
rarely cited. Similarly, Koenig reports that a study by Colantonio and colleagues25 "found lower rates of stroke in persons who attended religious
services at least once per week . . .".26 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,27 despite his own previous assertion that associations between attendance and health are highly questionable because this research is characterised by numerous methodological problems including the failure to adjust for confounders and
covariates.28

Finally, many studies evaluate differences in health indicators as a function of religious denomination (eg, ref 29-31). However, they are generally conducted precisely because religious groups differ on risk behaviours 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.32 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,33
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 005 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 randomised clinical trial.34 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. 29 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 recognised 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.

Conflicting findings
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.20
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.35 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. Byrd34 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.29

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.

Ethical issues
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 colleagues9 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,38 already well established as significantly associated with
health. Although physicans 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.38 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.37 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.37
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.38

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.41 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.

Conclusions
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 behaviour 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 behaviours 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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37 Gould SJ. The mismeasure of man. New York: Norton, 1981.

38 Powell T. Regligion, race, and reason. J Clin Ethics 1995; 6: 73-77.

39 Prager K. For everything a blessing. JAMA 1997; 277: 1589