Prayer In America - Interview: Wendy Cadge Ph.D.

INTERVIEW SUBJECT: Wendy Cadge Ph.D.
FILM: Prayer In America
INTERVIEWER: Alison Rostankowski
PHOTOGRAPHER: Bob Huck

The segments included in this interview excerpt were recorded in Summer 2006, as part of PRAYER IN AMERICA. The documentary is a production of the Duncan Group. Iowa Public Television is the presenting station and flagship affiliate for the PBS system. Dr. Cadge is an Assistant Professor of Sociology at Brandeis University. She completed a Robert Wood Johnson Foundation Scholars in Health Policy Research Fellowship at Harvard University (2004-2006).

You’ve written at the beginning of your paper about national surveys that show a very significant percentage of Americans praying for their own health. Can you talk a little bit about those, about typical survey results that you might find?

My understanding is that the national surveys that are done by lots of different organizations, social science groups as well as newspapers, and other kinds of groups, show pretty consistently that more than 90% of Americans pray, and that close to 80%, if not a bit more than 80% of Americans, pray for their own health and the health of their loved ones.

And people ask the questions in slightly different ways, about slightly different topics. But, the results come back pretty consistently that such large number of Americans do pray and do pray specifically about their health or the health of their families.

This type of prayer activity in your mind do you think it’s particular to America or Americans?

That’s a great question, and I don't, I don't know the cross-national survey data that I would need to know. I’m pretty sure that Americans pray more or the percentages are higher in the U.S. than in other national contexts. But I can’t pull out the numbers for you.

I think in the same way, that religion takes a unique kind of form in the U.S., prayer likely takes a unique kind of form. But I’m not sure we know enough about what that form is to really articulate it in a clear way.

Why do you think that the American religious experience is a somewhat unique one, that prayer experiences are somewhat unique ones? Can you expand on that a little?

I think it has to do with American history. Certainly there are a lot of debates among social scientists about how important it is that here in the U.S. there are a lot of different religious groups and there have always been a lot of different religious groups. And there are some social scientists who think that because the religious groups can kind of compete with one another, that leads people to be more interested or to be more religious. Other people think that that’s really not what’s happening. It has to do with the fact that the U.S. has had such a long history of religious diversity, and there have just always been so many different groups here. So I think it’s mostly historical.

What is the significance in these kinds of studies and this kind of perceived relationship between prayer and health?

So scientists have, have often been interested in this question, what is the relationship between prayer and health? And there are basically two groups of scientists, scientists and medical doctors: One group is trying to figure out if the effect, if prayer has an effect on people’s own health. So, if I pray am I going to be healthier than someone who’s not praying; and then the second groups of scientists are trying to figure out whether the prayers of one person on behalf of another influence the other person’s health. So it's' really important for us to, I think, to make those two distinctions.

And then what I’ve been trying to understand is this question about whether the prayers of one person influence other people’s health. And I’ve been trying to review those studies, looking specifically at one kind of research model that’s used, which is the double blind clinical trial, in which people who are being prayed for don't know the people who are praying for them, and the people praying don't know the people who were ill, and people don't know, kind of which group they’re in, if they’re being prayed for or if they're not being prayed for.

What is intercessory prayer?

Most simply, intercessory prayer is just the prayers of one person on behalf of another. So, intercessory prayer happens in churches and synagogues every week when there are general prayers in which their prayers are offered for health or healing for members of the religious group, or for world leaders, or for other kinds of people. So, really simply it’s just praying for someone else who’s not yourself.

What have you observed about the kind of popular press’s coverage of these types of studies?

I think the press is curious about these studies mostly because I think most Americans are curious about these kinds of studies. So, each time a study has been published it’s almost always picked up by the press on the front pages of newspapers. And I think that helps to sell newspapers and magazines, but I think it’s more that. So many Americans are religious, so many Americans pray, we all have health issues and conditions, and there are lots of things that medical science can’t always explain. And I think that the media picks up on the prayer studies in particular because they're offering a different kind of explanation, and that’s of interest to people for all of these reasons.

Please summarize the key issues of debate around a scientific study of prayer, within the scientific community itself.

I can only speak to the scientists who are trying to understand whether the prayers of others have an effect on people that they don't know. I don't, I can’t speak to the how my own prayer might help myself. So that’s a separate question. But, if we think about the debate around studies of intercessory prayer in particular, I think that the big topics of debate are: First, does intercessory prayer have an effect. I mean are these studies actually showing positive results or not; I think there’s a second topic of debate about whether scientists should even be trying to figure out the answer to this question. I mean is this a question that can be answered scientifically or not; and then I think there’s probably a third topic of debate that’s about how these studies are used. Should these results, if there are positive results, imply different kinds of practices in hospitals or doctor’s offices? So I think those are the three main vectors, maybe, of debate.

What do researchers say about the limits of medical science in studying intercessory prayer?

There’s a lot of debate. So, when these studies first started to be published, and there really haven’t been that many, I mean if we just read the newspapers we would think that there are hundreds. And, in reality, the studies that I looked at, which were only the double blind clinical trials, it looks like there have been between 15 and 20 studies published in medical journals since 1965. So it’s just not that many studies, there’s a disproportionate amount of discussion and debate in comparison to actually the number of studies.

So the early studies in the 70s and 80s, and into the 90s, the early 90s, the researchers were mostly saying that prayer did have an effect on other people’s health. And, since the early 1990s, basically all the studies have found that there’s no effect. So, prayer, by strangers at a distance doesn’t influence the health of people who are being prayed for.

And so in the beginning the debate was all about, is this really the case and should we be changing our practices, and is this really science? I think most of the debate was about, is this really science, are these methods and findings reliable and valid, can they be replicated again, can other people find the same kinds of conclusions? And more recently, I think the debates have been, sort of similar but more about, do we really need to keep doing these studies? Now we have 15 years worth of studies that are basically showing no results. Why are we continuing to do this and continuing to discuss it?

And it’s interesting that some of the medical journals have even published articles, more recently that are kind of taking position saying, maybe we know enough about this or I think we know now that these studies have no effect, let’s move on to other kinds of questions.

Why did it change? Is it as, between the 60s and 70s, yes, maybe it works; 90s, no maybe it doesn’t? Is this because of methodologies or is something else going on?

I think it really just has more to do with the studies that were actually being done. So, the first big study that got a lot of attention was published in 1988 by Robert Byrd. And his was the study that had enrolled about 350, 400 patients at San Francisco General Hospital, who were in the cardiac care unit. And his conclusion from the study and, I think, the quote is something like, prayer to a Judeo-Christian God has a positive effect on health outcomes for patients in a cardiac care unit. So, he was clearly saying prayer has an effect. That study then was talked about into the 80s, actually probably into the 90s, because it was then replicated in the late 1990s by another researcher named Harris, who did a very similar kind of study in a cardiac care unit in another hospital. And he actually also found positive results. So there was the debate again.

So I think it has to do with what the studies have been saying. And, actually, I should probably change it to say that it wasn’t, it was more, maybe starting in 2000 that the results have all been, that there haven’t been results, rather than to the 1990s. So I think the debate follows the studies and was being found in the studies.

Maybe you can kind of summarize this kind of, as you were describing it, what, when these studies start, what they find, and as we move through to today, where, where we are today in that discussion.

So, the studies started in the mid 1960s. In 1965 there were two studies, one in Britain, one in the U.S., both looking at the effects of prayer on health: One looking at children with leukemia; and the second looking at adults who had chronic conditions. The, I don't think there were too many studies in the 70s. But then the next big study was really the study by Robert Byrd in the 1980s that looked at cardiac care patients, patients in a cardiac care unit at San Francisco General Hospital. And he argued that prayer did have a positive effect for them. That study was then replicated in the late 1990s by another researcher named Harris. He did a similar study in a cardiac care unit, and he also found that prayer had a positive effect.

But since that study in the late 1990s, the other studies that have been published since then, and most recently the study by Herb Benson is a very good example, haven’t found that prayer has had any kind of an effect. They, the positive effects were always debated, but I think because, since because 2000, there haven’t been any positive findings, and particularly since Benson’s study which was intended to be the largest study, the most well-designed study, the study that cost the most money, since they didn't see any effect, I think that that’s really changed the kind of debate.

Could you talk a little bit about that? I understand it was somewhat differentiating in terms of, a little bit more inclusive outside of the Christian tradition, but that, still, it was also maybe criticized?

So when studies were first conducted, they included only Christians, normally only Protestants, often people with out were Evangelical or Born Again. It was a, very clearly a, a Christian kind of prayer. When Robert Byrd did his study in the late, in 1988, he also included Catholic intercessors. And then some of the studies that were done later, like the Mantra Study, broadened up the group of people doing the praying, so they included Protestants and Catholics as well as Buddhists, Buddhist groups and groups in other religious traditions. I think in that study, and I’m not 100%, I can check, that they also included a website so that each patient who was included in the study, their name was submitted through the website to be put into the Jewish Wailing Wall. So they were trying to think about prayer in a much more inclusive sense.

The question, I think we then need to ask about that, is whether the prayer that’s being measured and studied resembles a kind of prayer that anybody in any of these religious traditions would actually identify or kind of would make sense of. And I think that that’s an important question. Sort of like putting a lot of different foods together and trying to see if they actually taste like any of the original foods. And I think, often times, that becomes somewhat controversial.

…And it’s kind of all mixed up so that, would the Buddhists say that this is prayer even though it’s being done by all these different traditions, or the Christians, or the Jewish people. I think it gets complicated. I think that these studies could be set up in such a way that, maybe some patients were prayed for by Christian intercessors, and others were prayed for by Jewish, or Buddhist, or Muslim intercessors, and then you could compare, theoretically, and see, well, are the prayers of one religious tradition more effective, or did they have better, sort of influences on health than others.

But Americans don't want to set studies up that way, because that could potentially suggest the one religious tradition or one set of prayers is better than another. So I think that people want the prayers to be all mixed up in a way that makes them not recognizable to anybody in the individual traditions.

And, and that’s sort of, a distinctly American thing?

That would be my guess, but, it’s hard to say. I mean the other way to think about this is what assumptions are being made in the ways that the prayers are being set up. And so there are assumptions about the fact that, first you can pray for someone that you don't know, that you have very limited information about, and that that prayer might have an effect; that you can pray for someone at a distance, even though you’re never going to meet them, and maybe you don't even know exactly where they are; that prayers are offered alone. That, as an intercessor, people are given the names and they normally pray individually rather than praying in groups, that the prayers are being offered to a God rather than to an intercessor. In the Catholic tradition, prayers are often offered to Mary; in Buddhist traditions that I’ve studied, there are often things we could call prayers offered to particular Buddhist monks. But the intercessor level doesn’t make it into these studies; it’s only to God.

And the third thing is that the prayers are always for good health outcomes, they’re never for the acceptance of a diagnosis, or for maybe coming to peace with a situation as, as it’s developing. They’re always about healing, which implies or, and not healing in a kind of healing of body and soul and general sense that may or may not be about being cured of my particular ailment. They’re about getting better and physically, you know, being in a different place. And those are all, they’re important assumptions, and they’re not assumptions that are shared by people in different religious traditions, often the religious traditions of the groups doing the praying, when you ask them what prayer is and, and if their prayers are having an effect, what they think that that would look like for the people who are ill.

So these are the assumptions of the researchers themselves?

That’s right.

Why are they coming at it this way? Is this because it’s a way to approach it scientifically or is there something more going?

No. I think there are a lot of ways to think about that. I mean practically the first thing I think we have to ask is, why are people studying prayer as opposed to another kind of religious intervention, so to speak? So, why not study rituals, or community gatherings, or something else? And the kind of cynical approach is to think, well, prayer doesn’t cost anything, you can often find people who are willing to volunteer to be intercessors, prayer looks like something that’s shared by people in all of these traditions, so it’s kind of pan-religious, and, therefore, can be accessible to people in different religious traditions.

So I think that it’s of interest for the historical and cultural reasons that we talked about. But I think it’s also, it appears practical from a research standpoint and, it can be set up in such a way that the research can proceed, kind of, this way. Some of the more recent articles that have been written, not about the studies, but kind of critiquing the studies or the articles I mentioned in the medical journals, trying to ask, well should we really be doing this? I've actually concluded that prayer is not a valid construct. There was one group or researchers who tried, planned to do a study, and they came together and were trying to set up their methodology. And as they were trying to figure out what prayer was, they couldn’t answer questions like how many prayers should be offered for each patient, how long should they be offered, who should be offering them? I mean things that you need to understand and have specified in very specific ways so they're the same for each patient. They couldn’t figure out how to answer those questions for theological and philosophical reasons, and, for that reason, they decided not to do the study, and instead wrote this article saying, that prayer really can't' be a kind of valid construct scientifically in their view.

Why, then, can you trace for an audience, why is it that these studies come out of, and I, and recognizing, of course, as you said, that in the larger scheme of things there aren’t that many, but in the scheme of the actual ones that have been published, you get these studies that are disparaged, or, and criticized? Can you, how could we account for this kind of burst of interest, in the last 20 years, and why does it suddenly become something that some in the scientific community think should, should be studied, should be talked about, and so heavy weights in the medical field start to take this seriously? How do we account for that shift?

I think there are a number of contributing factors, and probably more that I’m not thinking of. But the contributing factors that I think are important to mention, one is the emergence and development of double blind studies in the first place. So, this, they’re a relatively new kind of scientific technique that have really been used only in the last certain period of time, such that it could even be applied to prayer.

A second theme is a movement towards evidenced-based medicine. So the idea that, for all the different kinds of treatments and drugs, we need to have empirical evidence that shows that they have a positive effect on people’s health. So in some ways it’s an extension of evidence-based medicine.

I think that this is linked, quite a bit, to the movement towards alternative and complementary medicines, which people have read and understood in a whole range of ways. Some people have argued that alternative and complementary medicines have become so popular because Americans are looking for a broader range of treatments when they’re ill. So that could also be a kind of contributing factor.

You mentioned the Byrd study earlier and this came up in an interview yesterday, can you tell me a little bit about him? What is he arguing? How is this a kind of genesis of these kinds of questions?

My understanding is that Francis Galton was an 18th Century scientist who was really interested in the same question about whether prayers had an effect. And so he decided that one way to look at that would be to look at different groups of people in society. And he reasoned that clergy would probably have many more prayers said for them by virtue of the fact that they were clergy. And so if those prayers really did have an effect, he thought that clergy would live longer than others. And so he gathered some, just a relatively systematic data comparing clergy to other groups of people in society. And he found that clergy actually lived the shortest in comparison to the groups that he was comparing. And so he wasn’t really sure, I don't think, quite what to make of that.

But, his legacy is that you can ask questions, you can try to measure scientifically or statistically, things related to the effects of prayer on health. And it’s interesting around mortality in this example. It’s interesting that the first two papers about intercessory prayer that were published in the 1960s begin with the same exact quote from Galton’s work. Which is basically saying something to the effect of, there is no reason we can’t apply statistics or scientific methods to the study of prayer. And to not do that is to not, sort of, fully understand or fully practice what it means to be a scientist. So I understand him to be saying that, if nothing is outside the scientific realm, we can study prayer just as we could study any other number of things.

It’s interesting that you said that because in looking at and quoting in your article a lot of the reactions in the medical journals, there are clearly a lot of scientists that don't believe one should be asking those questions. And so, if we can break this down a couple of ways. I’d like to explore both the kind of scientific objections and then maybe some more of the philosophical, theological sort of criticisms. But what are the scientific objections here? Do they remain consistent or is there a kind of a shift in these criticisms as these studies get published?

I think it’s mostly that the criticisms, the list of criticisms gets longer with each study that’s published. So I think at first there were criticisms like, you don't have, there are enough, there aren’t enough people participating in these studies, the ways that you’re measuring prayer, that’s a main topic of criticism, for the reasons that we talked about. Is this a valid construct? How are you measuring it? Are you measuring it consistently?

There were a number of criticisms in response to Harris’ study. I believe it was in 1999, the, or the journal that published it published in subsequent issues I think 10 or 12 Letters to the Editor that were all taking issue with statistical issues, statistical questions around how you measure significance, whether the argument that they were making and the results that they presented actually was the case in additional analyses - how you interpret different kinds of things. There were very, sort of technical, specific statistical sort of issues with the ways that the analyses were done.

What about the moral, philosophical, theological questions?

I think that those questions come up quite often. And the argument is simply, I mean there are a number of arguments: One, people of faith will often say, we don't need science to validate or to show support for what we already know or believe to be true. So, sort of, maybe science is infringing in a place where we just don't need them; often religious leaders will say that the prayers that are being looked at and measured don't resemble prayers that they do. So that, even if it was possible to study this scientifically, the ways the studies are being done don't resemble what their theological positions, or their philosophical approaches to prayer are. So, that the results are meaningless to them.

You note in the study this kind of generalized approach to prayer, and you say prayer is seen as an analytical category itself with some essential meaning rather than as something that is tradition.

So the ways that prayer is thought about and measured in these studies is not particularly Christian, or Buddhist, or Jewish. It’s often some kind of combination that involves intercessors from each of those different groups. And, assumes that what results these three different kinds of prayers, from these three different kinds of traditions, for example, mean something to the people who are doing the praying, or to the person who’s being prayed for, or to others who are reading the studies. And they make it such that that prayer becomes its own thing that isn’t identifiable to really anyone of any particular religious tradition; it becomes its own analytic category that doesn’t have any meaning outside of that.

Another way to maybe think about this, or put it is that, in one of the articles that was trying to think about whether prayer is a valid construct, the articles basically concluded that prayer exists only in the context of our ongoing human relationships. Prayer exists and means something for an individual in their relationship with their faith tradition, or their faith community. And to abstract prayer from the tradition, and the faith community, and the human relationships through which it exists, makes it an analytic category that doesn’t make any sense, it doesn’t exist, it doesn’t mean anything.

Dr. Koenig, when we spoke with him last week, pointed out to me that there were so many other studies around religion and health, more broadly. If there are all of these studies out there in the medical and scientific community, why is so much emphasis put upon this one particular type of study in your opinion?

I think that it’s because these are the kind of studies that require the biggest, kind of, leap of thinking. So that, when individuals, or when researchers ask questions about whether people praying for themselves can influence their health, we can, even if we don't believe that there are religious or mystical explanations, we can probably think about some reasons why prayer or, more often, meditation in these studies might calm people, or have some physiological effect, or something like that.

I think that the intercessory prayer studies are different and get more press because the kinds of explanations we might fall back on don't work, because there’s a space between the person doing the praying and the person being prayed for. And rather than it being a mother and a child, or a grandparent and a child, something like that, where you could say, well, these people know each other, so the child might feel more supported, or loved, or something like that, and that could influence their coping mechanisms.

The people who are being prayed for and doing the praying don't know each other, and so the kinds of explanations that can be used in some of the other studies about religion and health that are maybe outside of the religious field, for people who are skeptical about the religious explanations don't really work or make sense any more in the intercessory prayer studies because the prayer and the person being prayed for don't know each other.

Was there anything, as you were reviewing this body of literature and making these observations, was there anything in there that surprised you that you didn't expect to see, that you saw? And, if so, what is it about those studies that had that effect?

I was mostly intrigued about the degree of debate that there really was in the medical journals. So I thought that these studies could be published and the press might pick them up, but maybe the other physicians and researchers just wouldn’t pay too much attention because they would think it was bad science, or they would think that this is just another silly thing. And so I was really surprised about the degree of debate.

And I think the best example of this is this paper that was published by a researcher named, Leibovici. I’m not sure how you pronounce his name that was published in the British Medical Journal. And he actually said that he was looking at the effect of remote retroactive intercessory prayer. And he set up this study where he was looking at a hospital in Israel and he pulled patients who had been at the hospital on a particular time, and he had one person say a prayer over all of those patients. And then he was looking to see, or, sorry, he had this one person say a prayer over half of those patients, and then he was looking to see whether the prayers influenced whether someone got a blood stream infection or not.

Anyway, he set this whole study up, and he actually did the study, but he was trying to say, well if we’re arguing that there can be some force that can explain why intercessory prayer has an effect, why do we have to continue to assume that time is linear? We’re opening up a lot of questions. Maybe time isn’t linear and intercessory prayer can have an effect in retrospect.

Anyway, after this article was published, there were many, many, many articles and letters and the people wrote into the British Medical Journal for about three or four months, hundreds of them. And it wasn't until April that this researcher came forward and said that he’d actually done this study, but he was publishing it to make a point. And his point wasn’t that intercessory prayer might have an effect, his point was that this really, this question can’t be asked within the bounds of science. And he was trying to make that point by setting up what was basically a ridiculous study.

And so it was interesting to me to see the degree to which people responded to his study, and then he, sort of when he came forward and explained his whole motivation, the debate kind of continued.

But, I think that’s revealing on a number of levels, one of which is that, when he did that, he wasn’t just looking at intercessory prayer, he had to make it remote retroactive intercessory prayer. So that there had to be some other twist that was going make it kind of outside the realm of possibility.

Are these studies going to continue as a significant area of research? And, if not, why?

That’s a hard question to answer. My sense is that the studies will continue so long as researchers are interested in the questions, and there’s funding available to support them. I think that researchers are continuing to be interested in the studies, but perhaps less interested now because there have been this string of studies that didn’t have any results. And so that could lead people to kind of back off and work on other kinds of questions. It’s hard to know how the funding will develop, but I think that that has quite a bit to do with it as well.

A few general questions I’m asking of everybody, can you talk a little bit about, and just in general, what is prayer and why do people pray?

What is prayer? I don't think there’s any one generalizable description or definition of what prayer is. I think it’s usually understood as being the process through which individuals communicate with what their understanding of God, or the divine, or an otherworldly power or presence is. I think that that gets tricky in traditions that don't necessarily have that power or presence, like in some parts of the Buddhist tradition. But that’s probably the best I can do.

Why do you think people pray?

I think it’s a long list. I think people pray, for some people prayer is just the same as talking to you or I, so the question of why people pray is sort of like the question of why do you speak to others. That they believe that there’s a God or a presence out there and they are engaged in a continual kind of conversation with that being. I think that a lot of people think that others pray only to ask for things, and my sense is that that’s not actually the case, that people pray for, people pray and have this conversation about the activities of their lives. They offer thanks to the, this force that they believe is out there. There are certainly petitionary prayers, requests for things, but I think it’s a long list.

As we conclude is there anything that we missed or you would like to add?

It’s just really important that if you cite me as talking about prayer studies, you’re really clear that I’m only talking about this one set of prayer studies.