Faith & Healing: More patients ask for doctors' prayers

Faith & Healing

Faith & Healing

Can religion improve health? While the debate rages in journals and medical schools, more patients ask for doctors' prayers

By Claudia Kalb
Newsweek, November 17, 2003

On a quiet saturday afternoon, Ming He, a fourth-year medical student in Dallas, came across a man dying in the VA Hospital. Suffering from a rare cancer and hooked up to an oxygen tank, the man, an Orthodox Jew, could barely breathe, let alone speak. There were no friends or relatives by his bed to comfort him. When the young student walked into his room, the man looked at her and said, “Now that I’m dying, I realize that I never really learned how to live.” Ming He, 26, had no idea how to respond.

I thought, ‘My God, the chaplain doesn’t work on weekends, what do I do?’ ” She held the man’s hand for a few minutes in silence; two days later, he died. And as soon as she could, she signed up for “Spirituality and Medicine” at the University of Texas Southwestern Medical School, a course that teaches students how to talk to patients about faith and illness.

Many med schools around the world now offer such courses, largely because patients are demanding more spiritual care. According to a newsweek Poll, 72 percent of Americans say they would welcome a conversation with their physician about faith; the same number say they believe that praying to God can cure someone—even if science says the person doesn’t stand a chance. On Beliefnet, a popular interfaith Web site, fully three quarters of more than 35,000 online prayer circles are health related: patients’ loved ones—as well as total strangers—can log on and send prayers into the electronic ether. Popular practices like these, as well as the growing belief in the medical community that what happens in a person’s mind can be as important to health as what happens on the cellular level, are leading many doctors to embrace the God they banished from the clinic long ago.

All over the medical establishment, legitimate scientists are seeking the most ethical, effective ways to combine patients’—and their own—spiritual beliefs with high-tech treatment. Former mutual-fund tycoon Sir John Templeton spends as much as $30 million a year funding scientific projects that explore the nature of God. “The Anatomy of Hope,” a meditation on the effects of optimism and faith on health, by The New Yorker magazine’s medical writer Jerome Groopman, M.D., is coming out early next year. The U.S. National Institutes of Health plans to spend $3.5 million over the next several years on “mind/body” medicine. “There’s been a tremendous shift in the medical profession’s openness to this topic,” says Dr. Andrew Newberg, a neurologist at the University of Pennsylvania who is studying the biological effects of meditation and prayer on the brain. “People like me are very intrigued by what we’re seeing.”

Modern medicine, of course, still demands scientific proof on top of anecdotal evidence. So over the past decade, researchers have been conducting hundreds of studies, trying to scientifically measure the effects of faith and spirituality on health. Can religion slow cancer? Reduce depression? Speed recovery from surgery? Can belief in God delay death? While the research results have been mixed (chart), the studies inevitably run up against the difficulty of using scientific methods to answer what are, essentially, existential questions. How do you measure the power of prayer? Can you separate the health benefits of going to church or synagogue from the fact that people who attend religious services tend to smoke less and be less depressed than those who don’t?

For critics of this trend, that’s precisely the problem. In 1999, crusading Columbia University Prof. Richard Sloan wrote a paper in the medical journal The Lancet attacking the faith and healing studies for weak methodologies and soft thinking. Along with a second paper published a year later in The New England Journal of Medicine, the broadside ignited furious letter-writing campaigns in the academic press and divided the medical profession into two camps. Some scientists, like Sloan, believe that religion has no place in medicine and that steering patients toward spiritual practice can do more harm than good. Others, like Duke University’s pioneering faith-and-medicine researcher Dr. Harold Koenig, believe that a growing body of evidence points to religion’s positive effects on health and that keeping spirituality out of the clinic is irresponsible.

To make sense of the morass of data, the NIH commissioned a series of papers, published earlier this year, in which scientists attempted to definitively assess the state of the faith-and-health research. Lynda H. Powell, an epidemiologist at Rush University Medical Center in Chicago, reviewed about 150 papers, throwing out dozens that had flaws. In one respect, her findings were not surprising: while faith provides comfort in times of illness, it does not significantly slow cancer growth or improve recovery from acute illness. One nugget, however, “blew my socks off,” Powell says. People who regularly attend church have a 25 percent reduction in mortality—that is, they live longer—than people who don’t. “This is really powerful,” she says.

In an effort to understand the health differences between believers and nonbelievers, scientists are beginning to parse the individual components that compose religious experience. Using brain scans, researchers have discovered that meditation can change brain activity and improve immune response; other studies have shown it can lower heart rate and blood pressure, both of which reduce the body’s stress response. Dr. Kailash Nath Kanwar, former head of research and development for the Indian arm of a U.S. pharmaceutical company, was deeply skeptical of the power of meditation before his wife persuaded him to visit a swami outside Bangalore. Racked with back pain, Kanwar spent nearly a month at an ashram with the guru Sai Baba, meditating and following a strict vegetarian diet. When he returned to New Delhi, his back pain disappeared. Now he’s a true believer, and has since visited Sai Baba twice more. “We know very little about spirituality,” says Kanwar, 79. “It’s beyond explanation but it’s very potent.”

Using prayer to affect health is perhaps the most controversial subject of research. In the newsweek Poll, 84 percent of Americans said praying for others can have a positive effect on their recovery, and 74 percent said that would be true even if they didn’t know the patient. But what does the science say? At a meeting of the American College of Cardiology last month, Duke researcher Dr. Mitchell Krucoff reported preliminary data on a national trial of 750 patients undergoing heart catheterization or angioplasty. A group of patients who were prayed for (by, among others, Roman Catholics and Sufi Muslims in the United States, Buddhist monks in Nepal and Jews at the Western Wall) did no better than a second group that received standard care or a third, which was given a special program of music, therapeutic touch and guided imagery. But a fourth “turbocharged” group, which received both prayers and the music program, had death rates 30 percent lower than any of the other patients. “Despite all the attention modern medicine has paid to new technology, it has neglected to ask what happens if you pay attention to the rest of the patient,” says Krucoff.

Overall, the prayer studies have not shown clear effects, and even religious proponents are skeptical that it can ever—or should ever—be tested. So many people already pray for the sick that scientists cannot establish a control group. And the studies prompt questions that no one will ever be able to answer: Can one extra prayer mean the difference between life and death? Can prayer be dosed, the way medicines are? Does harder praying mean better treatment by God? In the minds of many, especially theologians, those questions border on the sacrilegious.

Still, prayer can be an enormous source of comfort to patients and their families. After suffering repeated heart attacks, Elizabeth Nascimento Silva was fighting for her life in the intensive care unit of a Rio de Janeiro hospital. Doctors had informed her family there was little they could do. But Silva, a devout Protestant evangelical, found strength by contemplating the scruffy hill outside her window. “I always thought of Psalm 121,” she says: ” ‘I will lift up mine eyes unto the hills, from whence cometh my help.’ ” Two months later she was released from the hospital; before long she was singing in the church choir again. “When you have faith, hope follows,” she says. “If I hadn’t had faith, I’d probably be bedridden or dead by now.” Some patients are convinced that their faith has actually healed them. Patrick Theillier, head of the Lourdes Medical Office in France, is charged with documenting the accounts of pilgrims who claim they have been cured at the holy site. “As a doctor, I cannot claim, ‘This cure is miraculous,’ ” says Theillier. ”[But] as a practicing Catholic, I can recognize that it is miraculous.”

Some experts worry, however, that faith can sometimes interfere with a patient’s journey through illness. Dr. Suki Tepperberg, a family physician in Dorchester, Mass., has concerns about those who put too much faith in God’s will. One of her patients, a Jehovah’s Witness who has diabetes and hypertension, believes her illness is in God’s hands and she sometimes eats destructively, harming her health. In her review of the literature, Powell found several studies suggesting that praying with a sick person can sometimes impede recovery; one study concluded that the risk of a bad health outcome doubled, perhaps because patients believed God would protect them or that their illness was some kind of divine punishment.

Interpreting disease as retribution for sin has its roots in the Bible—Miriam and King Uzziah were struck with leprosy after offending their God—and it continues to haunt many patients today. Kenneth Pargament, a psychology professor at Bowling Green State University in Ohio, studied the religious coping methods of almost 600 patients with diseases ranging from gastrointestinal disorders to cancer. Those who thought God was punishing or abandoning them were up to 30 percent more likely to die over the next two years. “Spiritual struggles are red flags and need to be taken seriously,” says Pargament. “We don’t want to turn the medical profession into clergy and chaplains, but to treat these struggles as divorced from the patient’s medical problems is shortsighted.”

Koenig, director of Duke’s Center for the Study of Religion/Spirituality and Health, is leading the charge for a better understanding of patients’ religious and spiritual beliefs in the medical setting. “It just makes too much sense,” he says, when patient after patient tells him, “Doctor, religion is the most important thing; it keeps me going.” Koenig advocates that doctors take spiritual histories of any patient they are likely to have an ongoing relationship with, asking questions like: “Is religion a source of comfort or stress? Do you have any religious beliefs that would influence decision making?”

Not asking can have devastating consequences, says Dr. Susan Stangl, a family-medicine doctor at UCLA. Stangl recalls a Muslim patient who needed medication, but was observing Ramadan and couldn’t drink or eat during the day. After taking a spiritual history Stangl chose a once-a-day medication that could be taken after sundown. “If we hadn’t talked about it, I would have written him a prescription for four times a day and he would not have taken it,” she says.

Today, more and more medical schools are offering specific courses in spirituality or incorporating the theme into the curriculum. Twenty years ago, recalls Marie-Pierre Girard, French medical schools didn’t offer any classes in humanities. “They now take into account the whole of the human being and offer a more humble take on what we as doctors can do,” says Girard, who practices in a prison southwest of Paris.

Columbia’s Sloan agrees that patients want to be treated “as people and not lumps of tissue.” But he is concerned about religion creeping into the physician’s domain. Problems range from simple logistical issues, he says—physicians barely have enough time to ask how patients are feeling, let alone inquire about their faith—to ethical blunders. Doctors should feel free to refer patients to hospital chaplains, but that’s as far as the religious conversation should go. “Nobody disputes that in times of difficulty, religion provides comfort for an enormous number of people,” says Sloan. “The question is whether medicine can add to that. My answer is no.”

Few would disagree that doctors have to tread carefully. Dr. Jim Martin, head of the American Academy of Family Physicians, teaches residents to take spiritual histories, but “if a patient flinches, we don’t go there.” And if a patient says faith or spiritual beliefs are not important, “we check that box and move on.”

Even advocates of prayer in the clinic are concerned about practitioners like Dr. Darrell Hermann. A pediatric surgeon at Baylor, Hermann says he felt compelled to raise prayer with Tiffany Webb and Jeff Fendley, a young couple whose baby was born with dangerous abdominal-wall defect, even though he had no idea if they were religious. “I heard them make a comment that they wished she’d get better and I said, ‘You could take this a step further. You could pray’.” Fendley says he was pleased to make a religious connection with his baby’s doctor and that it helped him cope with the severity of her condition. But other patients might have seen it as an unacceptable intrusion. And so debate rages on, from the ivory tower to the bedside of a very sick child.


With Anne Underwood, Ellise Pierce, Joan Raymond, Jenny Hontz, Karen Springen, Ian MacKinnon, Marie Valla, Mac Margolis, Liat Radcliffe and Sarah Childress

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