Teams of medical researchers around the world struggle to discover effective vaccines, treatments, and cures for diseases whose effects range from inconvenient to fatal. Unfortunately, many such studies necessarily involve the use of experimental animals, which may undergo subjugation to therapies that are liable to maim or kill. Even humans may suffer during clinical investigations. For these and other reasons, it is easy to understand the attractiveness of the notion that there might be less damaging roads to recovery, including the use of prayer in the healing of disease.

Prayer Data

Critical readers of reports relating prayer to illness recovery have reason to question reported outcomes. In 1988, the Southern Medical Journal published Randolph Byrd, M.D.'s study on intercessory prayer (prayer by outsiders, at a distance, as opposed to personal prayer) in treating cardiac care unit patients.¹ Among the prayer group, as compared to the controls, the article reported lesser incidence (5% to 7% reductions) in a number of complications, such as congestive heart failure, pneumonia, need for diuretic therapy, and respiratory intubation and ventilation. But Byrd found no significant difference in variables such as death rate, length of CCU stay, and total days hospitalized. Byrd also included a summary of several previous attempts to demonstrate the healing power of prayer, with results ranging from mixed to negative.

Critical examination of this study revealed flaws that appear to render the effort no more useful than those that preceded it. For example, the complications for which he reported significant reductions were not independent variables -- the development of one (e.g., congestive heart failure) may automatically have lead to a cascade involving numerous others such as diuretic therapy, respiratory intubation/ventilation, and pneumonia).²

Larry Dossey, M.D., a retired internist affiliated with the NIH Office of Alternative Medicine, has authored several books about the power of prayer in the practice of medicine. The Introduction to Healing Words³ cites Byrd's study as the seminal event that led Dossey on his own quest to document prayer's healing powers. Yet later in the book (p. 185), he cites my critique⁴ of Byrd's study, and acknowledges that the study had actually "missed the mark. . . . [S]tatistically significant life and death effects . . . simply did not occur."

Herbert Benson, M.D., cardiologist and founder of Harvard's Mind/Body Medical Institute, is a well-known author of books extolling the virtues of prayer and meditation (the "relaxation response") in curing and relieving symptoms of medical conditions. But the accuracy of some of Benson's writings has been brought into question. One example is the claim that employing the "relaxation response" helps achieve a 35% rate of pregnancy in women with unexplained infertility. The original research article which Benson co-authored⁵ contains "no evidence that the relaxation response improved the conception rate, as the authors are careful to point out there; there were no matched controls, they note, to show what the conception rate would have been without the relaxation response."⁶

Prayer and the Media

A 1996 newspaper article⁷ describes a conference at Harvard Medical School on spirituality and healing in medicine. Dale Matthews, M.D., an associate professor of Medicine at Georgetown University School of Medicine, is quoted as saying, "People with a strong religious commitment are less likely to . . . engage in [unhealthful] behavior" in the first place. Other studies seem to indicate that, at least among the elderly, people who pray at home and remain cloistered tend to do less well than those who may shun prayer but who participate in civic activities.^8,9 Thus if religion plays a role in healing, perhaps it is through its social aspects rather than through the answering of prayers.

But Matthews acknowledges regularly praying with his patients and hopes to prove prayer's medical efficacy. His most recent effort in this regard was conducted during 1996-97 in Clearwater, Florida, and his findings are currently awaiting publication. At about the time the study concluded, Matthews was quoted as having told the following to "a slightly bewildered crowd" of future doctors at St. Louis University School of Medicine: "The medicine of the future is going to be prayer and Prozac. If we can prove the medical benefits of intercessory prayer, it's going to be page 1 news. You're going to see a revolution. The world of medicine will be turned upside down."¹⁰

During the Matthews study's data-gathering stage, press reports kept the public apprised of its progress, and offered tantalizing hints of a successful outcome to follow. According to reports, Matthews' study involved 40 patients suffering from rheumatoid arthritis and tested for the effects of intercessory prayer (prayer by outsiders, at a distance, without the patients' knowledge). For reasons to be made clear in his published paper, all 40 patients (including those in the "control" group) were initially treated with "an intensive, hands-on faith-healing session."¹¹ Only after this course of prayer therapy, which would be expected to result in some patients reporting immediate subjective improvement in their symptoms, were the patients then divided into two groups -- the test group (to receive daily intercessory prayers from a designated priest) and the control group.

As was the case in the Byrd study, such an experimental design can only hope to determine whether or not whoever is at the receiving end of the intercessory prayers (God) requires constant, repetitive prodding, and then delivers healing incrementally as opposed to completely and immediately. Nor can we assume that the "control" patients were not receiving intercessory prayers from friends and family. All we know is that each "control" patient received one less intercessory prayer per day than had he/she been a "test" patient (e.g., perhaps five instead of six).

According to a Tampa TV news report,¹² there were 60 subjects, not 40, enrolled in the study, and three groups, not two. The control group (presumably 20) received no prayer at all -- neither hands-on nor distant -- while the other 40 were divided into the two groups described above. If this account is accurate, the control patients knew, since they were left out of the hands-on sessions, that they were indeed the controls. Another TV station's report¹³ also cited "60" patients. But my print references specify "40"¹⁴ and "about 40."¹⁵

According to the earlier TV report,¹⁶ "Nurse Practitioner Sally Marlowe is responsible for examining patients at each phase, and says preliminary results are dramatic." Marlowe then told the reporter, "I saw a woman who had a very great time, and had for years, getting out of a chair, just able to stand up out of the chair, and this was something that she hadn't done in years." At this point, the report cut away to Dr. Matthews, who offered, "We can say, clearly, that these patients are feeling better." Whether he means that the "test" patients were feeling better than the "controls" was not explicitly made clear.

Assuming that standard, double-blind controls were in force, one could not know whether the woman was in the test group or the control group. Such controls were called for in the study, for as Marlowe told another reporter, "This is the first time in medical history that we have evaluated prayer with the same type of protocol, under the same stringent conditions and regimen, as one would evaluate a new drug."¹⁷ But if the investigator had somehow, even inadvertently, become aware of which patients were receiving prayer and which were not, the risk of contaminating the patients (if only through body language) would increase. This could in turn lead the "test" patients to report feeling "better" than they might have otherwise.

About seven months after this TV report aired, a similar news story on another Tampa-area station aroused similar concerns.¹⁸ Marlowe was filmed examining the knees of a patient and was observed telling her, "That's coming along really nicely." If this patient was enrolled in the study (such was not explicitly stated), and/or if this video clip was representative of the manner in which findings were determined, the patients might not have needed to pick up on Marlowe's body language to have inferred their group assignment.

This second TV reporter stated that she was then "allowed to see the charts of two patients." Marlowe, pointing to her recorded findings for one of the patients, explained, "All of these represent tender joints." Then, pointing to the corresponding column of the second chart, she says, "These are his [tenderness findings]. There aren't any. It's zeros." As I suspect most viewers did, I could not help but infer that the patient who was doing better was being prayed for, and the other was a control patient.

Doubts About Prayer

The vast majority of the U.S. population -- patient and physician alike -- believes that there is a God who responds to prayer. Patients' utilization of prayer in recovery from illness is understandable. And a physician's participation is a logical extension -- why not pray with patients, if a divine entity might respond by accelerating improvement? And what harm could possibly derive from physician participation in prayer?

One might argue that there is no apparent downside and much to be gained by incorporating prayer into illness management. But what of the physician who might not care to participate in such activity, either for scientific or personal reasons? Incorporation of religious observance into medicine could artificially divide the physician and patient communities into unreconcilable camps. Use of public funds might also raise constitutional issues.

What about the matter of differences between various religions? Suppose a patient's religion teaches that, in order to gain God's ear, one must offer a sacrificial animal at the time of prayer? Should the doctor's office, or the hospital's surgical suite, become the venue for ritual sacrifice? At what point might a physician's nonparticipation in prayer-related activities become fodder for a charge of religious discrimination?

Western societies traditionally maintain a separation of religious and biomedical functions. Additionally, the scientific community at large has yet to accept prayer as efficacious treatment, because of the low quality of scientific evidence. In general, prayer studies have not been directed by skeptical scientists, but by physician proponents of prayer. As alluded to earlier, methodological flaws seem to plague the field.

In Healing Words, Larry Dossey suggested that the mechanism by which prayer works seems not to require an intermediary "God" at all, but rather appears to be the direct consequence of one person's thought waves interacting with another person's body. But does replacing "God-answered prayer" with "psychic power," for which the quality of evidence is comparably low, moot the downside of physician engagement in unscientific practices?

The scientific rules of evidence cannot be bent, even in the noble pursuit to prove the medical efficacy of intercessory prayer. The null hypothesis states that a proposed theory is prudently assumed false until such time as the evidence in its favor is sufficiently persuasive to convince those with no vested interest in a positive outcome. A generally accepted corollary states that the more extraordinary the claim (especially if it invokes supernatural mechanisms), the more extraordinary the required evidence.

Time will tell if Dr. Matthews' recent study will supply the long-sought extraordinary evidence of the medical efficacy of intercessory prayer. Upon its publication, we plan to take a close look and offer an appraisal. However, the history of such prior studies, and the preliminary media coverage surrounding this one, raise nagging concerns that may not be easy to dispel.

Read my follow-up article following publication of Matthews' study

References

1. Byrd R. Positive therapeutic effects of intercessory prayer in a coronary care unit population. Southern Med J. 1988;81:826-829.

2. Posner G. God in the CCU? Free Inquiry. 1990;10(2):44-45.  [Also posted here]

3. Dossey L. Healing Words: The Power of Prayer and the Practice of Medicine. New York, NY: HarperCollins; 1993. [Read my book review]

4. Posner, God in the CCU?

5. Domar A, Zuttermeister P, Seibel M, Benson H. Psychological improvement in infertile women after behavioral treatment: a replication. Fertility and Sterility. 1992;58:144-147.

6. Tessman I, Tessman J. Mind and Body (book review of Benson H. Timeless Healing. New York, NY: Scribner; 1996).Science. 1997;276:369-370.

7. Knight-Ridder News Service. Faith boosts health, survey of doctors says. Tampa Tribune December 16, 1996.

8. Associated Press. Doctors discover religion good for most people's health. Tampa Tribune. February 12, 1996.

9. Jancin N. Death risk after heart surgery rises for patients with no religious beliefs. Internal Medicine News & Cardiology News. July 15, 1993;1,26.

10. Sides H. Prescription: prayer. St. Petersburg Times (republished from New York Times Magazine.) December 29, 1997;D1-2.

11. Ibid.

12. Moreschi A. WFTS-TV 11:00 p.m. News (Tampa, FL). April 4, 1997.

13. Zelenko S. WTSP-TV 6:00 p.m. News (St. Petersburg, FL). November 24, 1997.

14. Sides, Prescription: prayer.

15. Pulley B. Putting prayer to the test. Florida Times-Union (Jacksonville). January 30, 1998.

16. Moreschi, WFTS-TV.

17. Zelenko, WTSP-TV.

18. Ibid.

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