Another medical paper questions the claim that supernatural belief and ritual are tied to physical well being. "Even in the best studies, the evidence of an association between religion, spirituality and health is weak and inconsistent..."

n article in the current issue of the prestigious British medical journal The Lancet questions claims which attempt to link religious belief with good health. While faith and religion may offer comfort to the ill, say the authors, there is no good scientific evidence that they cure disease or improve one's medical health.

   The study, "Religion, Spirituality, and Medicine" is authored by Dr. Richard P. Sloan, a psychologist , and colleagues E. Bagiella and T. Powell, all associated with Columbia-Presbyterian Medical Center in New York City. They conducted "a comprehensive, though not systematic, review of the empirical evidence" concerning claims linking religion and positive health, and also explored the ethical dimension of the related issues. Their conclusions are sure to stir more controversy in what has become a lively debate in both the medical and public policy spheres.

   rom Bible tales of miraculous healings to the new age claims linking "spirituality" and "wellness," the role of religion and the human condition has often divided believers and sober empiricists. Mary Baker Eddy founded the Christian Science movement, for example, and taught the alleged curative benefits of spiritual intercession, even going to the extreme of claiming "The less we know or think about hygiene, the less we are predisposed to sickness." More mainstream claims, though, linking faith and medical healing avoid that extreme, and suggest that spiritual faith and wellness are associated and/or causal.

   Naturally, there's plenty of misinformation -- a gap between the claims of those who promote the view that "religion is good for health" (including some medical professionals) and those who caution or reject that view altogether, finding empirical evidence of such assertions to be wanting. Even so, along with interest in "natural healing" as an alternative to hard medicine, there is widespread belief that prayer or other religious ritual can be physical beneficial.

   Dr. Dale Matthews, author of the popular book "The Faith Factor," treks around the country addressing doctors, medical students, nurses and clergy. His message is simple: "Doctors need to pay attention to the fact that having a strong faith has an actual medical benefit." Matthews and others who agree with that premise often cite studies to bolster their case, such as the report of 4000 North Carolinians age 65 and over which supposedly found that those who participated in religious activities were 40% less likely to exhibit high blood pressure and the associated risks of heart problems. A "holistic" web site also claims, "Research has shown that religious people are less depressed, have healthier immune systems and deal better with addictions than the non-religious."

   There is also an abundance of anecdotal claims, much akin to reports of "healings" from Lourdes, or even the Sunday televangelist's broadcasts where people are "slain with the spirit" and cured of their physical maladies. Astounding stories of cancer remissions are popular, although skeptics point out that misdiagnosis can occur. Even if there are such remissions, is it due to the intervention of a spiritual being? Or prayer? For critics, the claim is indeed a leap of faith.

   But these beliefs linking spirituality and good physical health persists. As Sloan and his colleagues note, a recent poll of American adults found that 79% of respondents believed that religious faith can assist in recovery from diseases. 63% opined that physicians should discuss the issue of spiritual faith with their patience (a fact which the Sloan paper questions from an ethical perspective), while 48% of those admitted to hospitals "wanted their physicians to pray for them." The Lancet article likewise points out that "Nearly 30 US medical schools include in their curricula courses on religion, spirituality and health." Even more astounding are surveys which claim that physicians themselves seem to exhibit high confidence in the curative powers of faith. At an October, 1996 meeting of the American Academy of Family Physicians, 99% of those responding to a survey "were convinced that religious beliefs can heal," while another 75% "believed that prayers of others could promote a patient's recovery." Even with the possible bias that physician- believers were more likely to respond to the survey, it is still a significant and disturbing figure.

   How good is the evidence for the claims purportedly linking faith and physical health?

   The Lancet article suggests that these assertions are riddled with errors, and often oversimplify the very issues which need to be probed. Variables such as "age, sex, education, ethnicity, socioeconomic status and health status may have an important role in the association between religion and health," Sloan and his co-authors point out. Reports which support claims of a link between faith and good health need to present all of these variables in a dispassionate, empirical way. "Reports that fail to do this are incomplete and can be misleading."

The Lancet article may be found on the publication's web site. In addition, readers may wish to explore this issue further by reading to recent articles by Kevin Courcey which appeared in the American Atheist Magazine. "Trying to Make a Case for Faith Healing" appeared in the Spring, 1997 issue, and "Touched By a Feeling And High on Believing" was carried in the autumn, 1998 edition. Both are online at the American Atheist Magazine web site.

   One example involves studies on the health of those in directed religious service -- Catholic priests, nuns, monks and others in the faith profession -- and an associated reduction in morbidity. Sloan argues that any correlation here may be an artifact of researcher bias, since the subjects of such studies "are inclined to strict adherence to codes of conduct that proscribe behaviors associated with risk" like consumption of alcohol or meat, smoking, "psychosocial stress" or other variables. It would helpful to see this study compared to a comparable examination of, say, atheists who engaged in similar lifestyle choices and did not smoke, or avoided other risky behaviors. Would faith and belief still be a significant variable?

   Maybe not. One study discussed in Sloan's paper involved a comparison between secular and religious Kibbutzim groups which asserted that "all-case mortality" was higher in the secular group. This study controlled variables such as location, use of the same hospital and age (over 40). Does that demonstration the kind of link, however, that many "faith healers" would have us believe? Sloan urges caution, saying that these groups "differed with respect to dietary habits, smoking, blood cholesterol concentrations, and marital status," factors which even the study authors acknowledged. "The multivariate analysis of mortality did not control for these factors."

    Other medical studies come in for close scrutiny by Sloan and his associates...

   ¶    Surveys in Alameda County and Tecumseh County linked attendance at religious services with low mortality. After control "for all revenant covariates," though, the relation held only for women. Why? A similar study tried to link church going with "increased functional capacity in the elderly." Again, "after control for all relevant covariates," the relationship appeared for only 3 of the 7 years of data which were collected.

   ¶    Prosaic reasons rather than divine intervention or some hidden benefit of religious belief may account for some statistical outcomes. One can only wince in disbelief over assertions linking church attendance with "reduced capacity (and poor health)." Naturally, those with better health and capacity are probably better able to make the trek to church or, indeed, any other activity. This is comparable to arguing that participation is soccer games immunizes one from broken legs, because of the low percentage of soccer players on the field who exhibit such a malady. Really!

   ¶    Under "failure to control for multiple comparisons," the Sloan study argues that "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." One study, for instance, claimed an association between attendance at religious services and high levels of interleukin-6 in the elderly. Sloan notes that the levels of interleukin-6 was only one of eight possible variables, "and there was no attempt to control for multiple comparisons." A subsequent study found no significant association.

   ¶    In "Conflicting findings," The Lancet articles notes that published works in scholarly journals lack "consistency, even among well-conducted studies." One study may find "some effects" linking involvement with religious activities and functional capacity, but no similar association with the "private, reflective" aspects. In other words, prayer itself may not help if it is done in the privacy of one's home, whereas going to church could produce a different outcome. What might account for this? More revealing is that fact that other studies show no clear relationship between church attendance and "lower morality," or may suggest that relationship only for one group such as women.

   Experimental replication is a crucial part of the scientific method. Claims must be testable if they stand any chance of having merit and passing peer review . Indeed, the history of psuedoscience and "bad" science is littered with the debris from "one shot" experiments or questionable studies involving everything from cold fusion to curative powers of specific substances.

   News accounts of The Lancet article carried by Reuters, Bloomberg or other media dealt mostly with Sloan's refutation of sloppy empirical studies and their related claims, but paid scant attention to the concern over ethical issues. Sloan and his associates warn, "When doctors depart from areas of established expertise to promote a non-medical agenda, their abuse their status as professionals." Indeed, this same caution should be extended to scientists or others who exploit their credentials in one area, say biology or astronomy, to support questionable political or religious positions. Should doctors be making inquiries "into a patient's spiritual life" because of an improperly founded belief linking faith and good health? Should a physician "ask patients what he or she can do support their faith or religious commitment" as one writer advocates?

   Along with the issues of exploiting credentials to influence patience or exceeding the proper limits of medication intervention, Sloan also raises the possibility of doing actual harm -- a course of action explicitly proscribed in the Hippocratic Oath. "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." We are, as a society, hopefully well beyond the stage of "blaming the victims" of medical misfortune whether it involves a broken limb or psychological disorders. The "faith- health" nexus threatens to appropriate medical diagnosis in the service of making unfair moral judgments about patients.

   As for discussing religion in the context of health, Sloan agrees that there is no ethical objection to "co-worshippers" raising these issues together. But when one visits a dentist, internist, general practitioner, specialist or any other medical professional, one does not expect "spiritual guidance" or a religious lecture. Unfortunately, The Lancet piece -- published in a British journal -- does not touch on the potential legal problems of turning physicians (especially those in public hospitals, or paid by public funding such as Medicare) into religious advocates. Attention also needs to be paid to the issue of having public universities or colleges promote any faith-based healing agendas. Inevitably, that curriculum would likely reflect the biases of the predominant religion, Christianity, or focus on trendy "new age" or "native" claims of spirituality or wellness.

   "Even in the best studies, the evidence of an association between religion, spirituality, and health is weak and inconsistent," concludes Dr. Sloan's paper. He and his team find that it is "premature" to promote religious belief as an adjunct of medical treatments, though they do admit that belief "can bring comfort to some people coping with illness." Measuring somewhat amorphous concepts like "pain," or "a feeling of well-being," especially in a clinical and hospital environment, is tricky at best, and highly subjective. It may be that people who claim deep religious faith describe their symptoms and fortunes in a different way from, say, the non-religious; but that does not automatically translate into causative agents which relate to measurable levels of blood chemistry or other findings.

   Finally, there are plenty of things which people might do as part of their "lifestyle decisions" which, divorced from any religious belief system or context can have positive and therapeutic effects on health. Sloan cites simple (though not always easy) decisions to stop smoking or eating a sensible low-fat diet as steps in that direction. As for the assertion that religious belief is good for health, The Lancet article indicates that those who advance the claim have yet to demonstrate its validity through rigorous empirical evidence.

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