Some of you have suggested I keep these Skeptic online posts down to once a week, but this is so important I wanted to let you all know ASAP that the British medical journal Lancet, one of the most highly regarded medical journals in the world, has published an important review article that calls into question the so-called Faith-Medicine connection (prayer and healing, faith and healing, spirituality and healing, religion and healing, etc.). Here is a short summary I wrote up for Skeptic magazine News for our next issue, but definitely check out the article yourself. It will be a keeper.

Studies over the past several years 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 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 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."