Should Physicians Be Prescribing Prayer?

Howard Markel, MD, PhD

Disclosures

November 04, 2004

Last week, I saw an 18-year-old patient whose substance abuse problems appear to have been relieved by a transforming religious experience. Thanks to a bad bout of asthma, I happened to be wheezing and short of breath, and the young man asked if I would like him to say a prayer for me at his Bible study meeting that evening.

Almost reflexively, but not without some discomfort, I declined the offer. Later in the day, however, I began to wonder...why not? How could it hurt?

We are all used to hearing clergy members and others of strong religious beliefs assert that prayer can positively enhance our health. But doctors? Until a decade ago, merely suggesting that prayer, or religious faith, could cure disease would have invited skepticism if not outright ridicule throughout the American medical community. Yet nowadays, the idea is being taken seriously and some physicians are recommending prayer, meditation, and other spiritual practices to their patients.

Other doctors are advocating the importance of taking a spiritual history from patients to assess their religious beliefs. Such information, they argue, can help physicians and patients develop better regimens of medical care and facilitate end-of-life, reproductive, and other difficult clinical decisions.[1]

Although no definitive data exists proving the health benefits of taking a patient's spiritual history, there is some indirect evidence to support it. Opinion polls consistently show that between 60% and 90% of Americans believe in God or a universal spirit. A 1999 study in Archives of Internal Medicine reported that 90% of patients believed that prayer may sometimes influence recovery, and 94% agreed or strongly agreed that physicians should ask them whether they have religious beliefs if they become gravely ill.[2]

In a multicenter study published in 2003, 85% of physicians surveyed agreed that they should be aware of a patient's spiritual and religious convictions.[3] But only about 35% of these doctors said they should be the ones to actually ask patients about these beliefs. Another 2003 study reported that fewer than 10% of American doctors do gather such information, even from dying patients.[4]

This may soon change. Currently, 84 out of 125 American medical schools offer courses on religion, spirituality, and health. Leading national medical societies and organizations sponsor frequent conferences on the topic. Several academic medical centers boast research units devoted to studying the potential connections between spiritual and medical interventions; and leading health philanthropies and the National Institutes of Health are funding much of this research.[5]

Dr. Harold Koenig, a psychiatrist and Co-director of the Center for Spirituality, Theology, and Health at Duke University (Durham, North Carolina), believes there is excellent evidence that, at the very least, prayer can help patients to cope with serious or terminal illness, find meaning in their lives, and reduce the risk of clinical depression. He also suggested that attending religious services could improve a person's immune system and increase life expectancy (personal communication, October 2004).

However, another leading investigator of spirituality and health, Dr. Richard Sloan, a behavioral psychologist at Columbia University (New York City), said that despite hundreds of studies on the subject, no compelling evidence exists demonstrating that prayer yields better health (personal communication, October 2004).

He is not alone. Recently, Dr. Richard J. McNally, a psychologist at Harvard University (Cambridge, Massachusetts), told The New York Times: "intercessory prayer presupposes some supernatural intervention that is by definition beyond the reach of science. It is just a nonstarter, in my opinion, a total waste of time."[6]

Indeed, proving a link between better health and personal prayers, or even intercessory prayers, presents a host of methodologic challenges. How does one apply the tools of scientific investigation, with its demand for reproducible results, to matters of faith?

"No one disputes that for a great many people, religion brings comfort during times of distress, whether related to illness or other sources. Whether physicians can add to that matter is another issue entirely. Bringing religious practices into clinical medicine can result in ethical and purely practical problems that can actually harm the patient and can trivialize the religious experience," Dr. Sloan said.

This debate is not likely to be resolved soon. Given that so many Americans believe that prayer can benefit their health, it seems that the time for doctors to formally inquire about their patients' spiritual beliefs is long overdue. But, ultimately, it is the clerical professional, not the physician, who can best assist with matters of prayer and religious faith and help facilitate how they may contribute to a patient's treatments or medical decisions.

A former medical school professor once told me, "you have to remember, doctors don't save patients' lives, they merely prolong them." What I think he and my concerned patient were trying to teach me is that there is a critical distinction between the physician's goal of ameliorating illness and the divine act of healing.

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