Prayer In America - Interview: Richard Sloan, Ph.D.

INTERVIEW SUBJECT: Richard Sloan, Ph.D.
FILM: Prayer In America
INTERVIEWER: Alison Rostankowski and Chip Duncan

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. Sloan is the author of Blind Faith: the Unholy Alliance of Religion and Medicine. He is a Professor of Behavioral Medicine (in Psychiatry), at the New York-Presbyterian Hospital at the Columbia University Medical Center.

(* This transcript has been edited due to length.)

There are a number of studies that indicate what appear to be beneficial outcomes of religious activity. You’ve argued, when you look more closely at these studies, they’re not so much looking at religion as a factor influencing health outcomes, but health conditions. And I wonder, could you talk to that distinction and say why that distinction is important?

There are thousands of studies about religion and health broadly, but a much smaller number, actually, about the benefits of religious involvements, the health benefits of religious involvement. So there are many studies, for example, of denominational differences in one health outcome or another. So, for example, Catholics and Protestants are contrasted in cholesterol levels, or Jews versus Christians in Diabetes incidents. Those are studies about religion and health, but they have nothing whatsoever to do to, presumably, beneficial effects of religious devotion, they only have to do with denominational differences.

There are studies about the impact of health conditions on religious devotion. For example, some people may become more religious, others less religious, after a health crisis. Those also are about religion and health broadly, but not really about the presumed impact of religious devotion on health outcomes.

So there are many fewer studies that are actually relevant to the presumed benefits of religious involvement.

Could you give some examples? what are the problems with these studies?

The principle problem is that it’s very difficult to draw conclusions about the relationships, the causal relationships, between a religious involvement and health from what I refer to as observational studies. In an ideal situation in an experiment, what you would do as a researcher is to assign some people on a random basis to receive a treatment and other people, equally randomly, not to receive the treatment. This is what’s done by the pharmaceutical industry all the time. You actually conduct an experiment. And if it’s done properly than you can be certain that the two groups differ only in regard to one thing, and that one thing is whether they received the treatment or not. If there are health differences and outcomes at the end of the experiment, then you can be relatively confident that the difference is attributable to the treatment.

You can’t do that with studies of religion and health, because you can’t take a bunch of people and assign half of them to be religious and the other half not to be religious. But we, we simply can’t do that. And so what we’re left with is trying to find people who differ in their degree of religiosity, the degree to which they report going to religious services, or read the Bible, or involve themselves in prayer, or listening to religious radio. The problem is that those people self-select to those conditions and they may be different in many other ways in addition to their differences in their religious devotion.

So, it’s very difficult to know if there’s a health difference between the two groups, what it’s attributable to? Is it attributable, really, to the difference in religiosity? Or is it attributable to some other characteristics? This problem plays out in trying to make sense of the data. An early study on the relationship between church attendance and mortality makes this clear. This was a large study conducted in Washington County, Maryland, that showed, initially at least, that those who reported going to church more frequently were likely to be alive longer than those who, who reported going to church less frequently.

About six years later they, authors of that study, published another paper in which they essentially retracted that finding. Because they realized that they had failed to control for another factor, which was more likely to account for the findings than religiosity, and that factor was what is referred to as functional impairment. Those people who were already sick and impaired at the time that the original data were collected, were, of course, less likely to go to church because they were sick; and they were also, of course, more likely to die. And so what we really were seeing here was the fact that people who were impaired who were already sick, not only couldn’t go to church, so they were less likely to attend, but they were also more likely to die. So it was really a health, it was really a health condition influencing church attendance, rather than church attendance influencing a health condition.

What’s your impression of how popular culture or the media treat these types of studies?

The media is far too gullible and far less skeptical about reports, even anecdotal reports, let alone skeptical about studies associating religious devotion with health. In these days of corporate control of media, where the story has to sell, that is, very little sells more than religious miraculous cures. And so, they’re passed off without skeptical questions.

Taking a view over time could you talk to what, if any, flaws there have been/are in the methodology of these studies?

We are better today. And I think the studies are stronger today than they were 20 or 30 years ago. Nonetheless, even the strongest studies often suffer from very serious methodological flaws, flaws so serious that it’s impossible, really, to take the studies seriously.

And one of the characteristic flaws was described by Robert Park, the physicist and ardent critic of junk science, who wrote about the sharpshooter’s fallacy. The sharpshooter’s fallacy is that the sharpshooter empties the six-gun into the side of the barn, then draws the bulls eye. And that happens all the time in studies of religion and health. It happens elsewhere as well, but it happens, characteristically in studies of religion and health.

Variable, after variable, after variable is tested between, contrasted between people who are devoutly religious, people who attend church more often, people who read the Bible more often, and those who do so less frequently. And then, one of them appears to be significant. Ten or fifteen of the others aren’t significant, but one appears to be significant, and the researchers say, ah ha, there it is, see the difference. And, of course, if you controlled for the fact that you made 15 or 20 different comparisons, the one you found as significant would no longer be significant.

So, in other words, you're saying that there’s a kind of fishing for data.

Yes. The epidemiologists refer to it as data dredging. You keep fishing around; sooner or later you’ll find something that seems to be significant.

Why is it so prevalent in this particular field of study? You’ve obviously have some incredibly brilliant people who would know where some of these flaws might lie. So why do you think you see it so consistently?

I’m not sure that it’s any more prevalent in this field than it is in others. I really can’t say because I haven’t looked at other fields. It is much more common than it should be here and I don't know why that’s so.

Is there any way then from the scientific point of view, that you can do any kind of studies on this particular topic, in your opinion, that are sound?

I think it's extremely difficult and for the reasons that we’ve already discussed. Because you cannot control exposure to the treatment variable. You can’t make some people religious and others not, and then look at the differences in health. You’re stuck with looking at people who are already religious, people who are less religious, and people who are not religious at all, for example, and then looking to see whether they differ in certain health characteristics. And the problem, again, is that they may differ in many other respects, in addition to their differences in religious devotion.

It’s extremely difficult to tease apart these other factors.

In the medical literature on this topic what have you found? Is there a consistency in the results? And how would you characterize what you found?

We found an incredible number of extremely weak studies; studies that are misinterpreted, misrepresented; studies that proponents claim are strong indicators of a beneficial effect of religious involvement when, in fact, they’re not strong at all.

How would you characterize the local communities response to these kinds of studies? Are you a lone wolf in your reaction?

No, no, there are people who are skeptical. But, by and large, the medical community has embraced religion and spirituality in a way that I think is excessive.

There are cyclical trends in medicine, there are cyclic trends in American culture, and we’re in a period of ascendancy of religious involvement now. And this has been characteristic of American history. There have been these periodic waxing and waning of religious fervor. We’re in a period of ascendancy now, and I think it’s affected all elements of society including medicine.

I can’t help but notice that a large majority of these studies come out of the United States. Are we seeing this happening anywhere else?

No. It’s particularly American. In fact, it’s so American that people in other parts of the world have no understanding of what’s going on. They can’t understand why this is an issue in the U.S..

Some of the people, I suppose, would argue that religion, going to church, this whole kind of supportive religious environment or community helps people’s recoveries. How do you typically respond to that line of argument?

I don't see that there’s much in the way of evidence to support that. I think most of the data simply won't support that being religious improves your recovery from illness anymore than anything else. If you’re part of a community then there is evidence that being part of a supportive community is good for your health. And to the extent that religious communities provide that kind of support, then you might be on reasonably solid ground in inferring that, but religious communities are not the only kinds of communities. The problem is attributing it solely to religion and not to the community aspect.

When we talk about healing, it seems so distinctly American. But I’m wondering if it’s true when looking at religion as the cause of the illness of disease versus the curative nature of it?

Ah, that’s an interesting, I’m not sure that I know the answer for that question. Clearly there are cultures around the world that believe that there are magical sources of illness or demonic sources of illness and that may relate to issues more broadly about religion and health.

Whether that’s, I think that may be less characteristic, although not entirely uncharacteristic of the U.S., but, it may be characteristic of other societies, more so than the U.S..

How do you characterize the studies? I mean do they tend to be predominately Christian?

Almost all the studies in the United States are Christian, are based on Christian populations. There are some studies out of Israel, obviously they focus on Jewish samples. But, most of the literature is based on Christianity.

Is that because this is by majority a Protestant country, or do you see something else going on there?

It’s probably a combination of things, but certainly the primary reason is that this is a majority Protestant country.

Are there objections because of this kind of Christian emphasis? This is a theological objection, probably not a scientific one.

Yes. Well it’s scientific as well. Not only are most of the studies based on Christian populations but a very substantial fraction come from the Bible belt. Not all of them, but a very substantial fraction. And many of the high profile researchers come from institutions in the Bible belt and draw samples from there.

Is that true of the Robert Byrd study, for example?

Ah, no, the Randolph Byrd study is an entirely different, a bird of an entirely different feather, so to speak.

What’s the typical response to scientists who might be criticized for maybe conflating their religious opinions with their scientific opinions? How do they respond to that criticism?

They point to what they believe is the solid science that they report.

Well let’s talk a little bit about the ethics, then, of this. You’ve actually argued these studies do actual harm and may rather ...

They can do harm.

Oh, they can do harm. Can you give me a kind of explanation why that might be?

There are at least three serious ethical problems associated with attempts to bring religious practices into clinical medicine, which is what we’re talking about. And they are actually causing harm, invasions of privacy, and the possibility of manipulation, of coercion.

So let’s talk about the last one first. We all recognize that the relationship between physicians and patient is an asymmetrical relationship. Physicians are experts in the relationship and the patients engage in the relationship to seek that medical expertise. And that difference in power between physician and patient is entirely appropriate when medicine matters are being discussed. But when physicians pursue an agenda outside medicine, but in, still in the context of the physician patient relationship, it has the possibility of being manipulative or even coercive.

There is a wonderful example that appeared in the media. Several years ago, a CBS Sunday Morning news program in which, which featured a Colorado orthopedic surgeon who prayed with his patients. When does he pray with his patients? Does he pray during the initial visit when a decision to proceed with surgery is made? No. Does he pray when the patient comes in for pre-surgical testing? No. Does he pray when the patient arrives at the hospital for, on the day of surgery? No. This physician prays with his patients when they’re gowned and supine on the gurney. And he then asks, is it okay if we say a prayer? No, he’s essentially holding a scalpel to their throat, they’re about to go into surgery, and he’s saying, is it okay if we say a prayer before surgery? Who is going to say no under those circumstances? Nobody. Nobody will say no to somebody who’s about to have their medical future in his hands. So that’s very clear there, that’s not just manipulation, that’s outright coercion, and it’s completely unacceptable.

You often hear the argument which is a more holistic approach, I’m going to ask a patient whether they smoke, whether they drink, and are they religious? As part of these general medical history questions, then where is the objection?

No, I have no objection whatsoever to asking those questions. Do you smoke, do you drink, do you have a gun in the house, are you religious? You ask the question, you move on. There’s a difference between asking that information and using it as the object of an intervention.

I think you should, physicians have to ask questions about things that are important to their patients. And for many patients religion and spirituality are important. And physicians need to know that. What they don't need to do is to conduct a detailed spiritual inquiry, as many recommend. And they certainly don't need to manipulate or even coerce patients into engaging in religious activities that violate their own sense of what’s important religiously.

You just mentioned this kind of spiritual inquiry. What kind of things beyond just asking are you religious, where might this go?

Several physicians have published a set of questions that they recommend that constitute a spiritual history. Harold Koenig has published five questions. Christina Puchalski, who’s very active in this field, has published a spiritual history that consists of four questions. In my view it’s completely inappropriate to conduct a spiritual history. I think it’s important for you to ask what’s important to your patient. And if the patient says, religion and spirituality are important, you need to know that. But to go on and conduct a detailed spiritual history suggests that there’s an importance to this aspect of the patient’s life, over and above other aspects of the patient’s life, and that may not be so.

You also mentioned the danger of privacy. Can you expand on that?

Yes. There are a great many factors in our lives that we can show are related to health that are nonetheless seen as out of bounds for medicine. And the best example is marital status. There’s abundant evidence now that being married is good for your health. People who are married live longer and they live healthier lives than people who aren’t married. But we don't expect physicians to make recommendations to marry, to their single patients on the basis of this evidence. We don't expect patients to say, Bob, I see here that you’re a single man and you’re 35 years old, and I want you to know about this evidence that suggests that being married is good for your health, I think you ought to get married. If the physicians said that to you, that would be the last time you’d ever visit that physician. And we believe that this is a violation because marital status is personal and private, and out of bounds for medicine, even if we can show relationships between it and health outcomes.

That applies equally, and perhaps more so, to religion and religious devotion which for many people is personal and private.

I asked Harold Koenig about that. His response noted that’s all we're asking the doctor to do, patients already are religious, we’re just saying, let the doctor acknowledge that and learn about that. So, what would your response be?

Acknowledge that and learn about it?

I don't know what that means. I certainly think it’s important for physicians to know whether patients are religious or not. I don't think it’s appropriate for patients to conduct detailed spiritual histories, as Dr. Koenig recommends. I don't know what it means to learn about it - unless he means conducting a detailed spiritual history. Why not ask a history about sports? After all, sports are enormously popular in the United States. Sports may have health implications. Certainly being in good physical condition protects you against certain diseases. Engaging in certain sports, extreme sports, like parachute jumping, for example, may place you at greater risk. Should physicians conduct sports histories? Should physicians conduct histories about other aspects of patient’s lives? They should learn what’s important to their patients and then move on.

Actually, I’m sorry would you read me what he said, that we ask questions about being married?

I’ll read you the exact quote ... “That’s all we’re asking the doctors to do…We’re not asking them to tell patients to become religious, get religious, they're already religious. We’re just saying let the doctor acknowledge that and learn about that.”

Well, I certainly agree that physicians ought to learn whether to their patients, religion is important to them, as they are to learn about other important things. Dr. Koenig may have changed his position, but in a book he published in 1999, he makes very detailed recommendations about how both non-religious and religious patients should engage in more religious activities in order to improve their health. So, perhaps his position has changed in the seven intervening years but, in 1999, Dr. Koenig thought it was important for physicians to make recommendations about patients’ religious behavior.

There’s pervasive dissatisfaction in the United States today about healthcare, from physicians and from patients. Everybody complains about the impersonality of healthcare. And that’s a very serious problem. And it’s undoubtedly one of the reasons why patients are embracing the idea that religious practices can be good for your health.

But, as HL Mencken said, for every complex problem, there’s a solution that’s simple, neat, and wrong. And bringing religious practices into medicine, it meets Mencken’s concerns. Let me say that again.

Bringing religion, religious, bringing religious practices into medicine makes Mencken’s point: It’s simple, and it’s neat, and it’s wrong, because of the ethical considerations that we've already discussed. And I have some more to get to as well as the complete lack of solid evidence that there’s a relationship. But it’s also wrong because there’s a better solution, and that is to make medicine more humane without resorting to gimmicks.

Now, of course, it’s a tall order in the United States because of the financial pressures that require physicians to use more and more tests, high technological tests, and to spend less and less time with patients. That’s a huge impediment. But that’s really the problem, that’s why medicine is, is criticized these days.

So, we’ve talked about manipulation and coercion, and we’ve talked about privacy. The third significant problem is actually causing harm. And my, almost my first encounter with this field now 25 years or so ago, still provides one of the best examples of how this belief that religious practices can improve your health can cause harm.

I was collecting data for a research project that involved women who were awaiting the results of gynecologic biopsies. And I was interviewing a woman in a semi-private room separated from the other patient in the room by a curtain. Both were awaiting the results of gynecologic biopsies. And while I was interviewing my patient, the patient in the other bed was surrounded by her family, and in walked the doctor with her biopsy results, which were negative. Great relief to everybody. Her father exclaimed, to nobody in particular, we’re good people, we deserve this.

Now that’s a perfectly understandable thing for the father of a potentially sick young woman to say. But what was the young woman I was interviewing suppose to do when her biopsy came back positive? Was she supposed to say to herself, I’m a bad person, that’s why I got cancer? I’ve been insufficiently devout, that’s why I got cancer? It’s bad enough to be sick, it’s worse still to be gravely ill. But to add to that the burden of remorse or failure over some supposed failure of devotion. Let, let me say that again.

It’s bad enough to be sick, it’s worse still to be gravely ill. But to add to that the burden of remorse or guilt over some supposed failure of devotion is simply unconscionable. But that’s what you get when you make claims, or even imply that religious devotion is good for your health. If you say that, you imply that failure to be devout is bad for your health. And that’s simply unconscionable.

If this causes actual harm, how do you make the distinction between the realms of religion and the realms of science? Obviously, different domains and different roles. So how, how do you distinguish?

They’re completely domains. Now, obviously philosophers have been thinking about this distinction for a very long time and people have different points of view. As I see it, religion and science on, more generally in medicine, more particularly, are just different domains of, different ways of knowing things in the world.

The position that Stephen Jay Gould took, I think, is the one that’s most appropriate. He defines them as different domains, each with different rules, different approaches to understanding the world. You can’t reduce religion to science and you can’t reduce science to religion, and you shouldn’t attempt to test the tenets of religion by applying scientific methods. It’s a violation of religion to do that. And that’s a very serious matter that the proponents of bringing religion into medicine failed to consider.

Do you come across a lot of objections to these studies from the religious community? Or is it just coming from the scientific community?

No, there, some people in the religious community embrace attempts to bring religion into medicine; others are rebuffed by it because of the problems associated with putting God to the test, for example, bringing God into the laboratory so that you can test the tenets of religion.

Another Koenig response around this issue, about this notion, maybe they feel guilt, or remorse, or something. When I asked him about this he said, people are naturally going to think, religious people I’m assuming, that God is punishing me, but they don't have anyone to talk to about that. They sit there struggling with these kinds of beliefs, they feel guilty, they feel punished, they feel angry. And those feelings adversely affect their medical outcome but no one noticed because the doctor hasn’t asked. And he says, if the doctor does ask, the patient is more likely to talk about it with their physician than with their pastor or clergy person. They feel the doctor isn’t judging them. So, is that a legitimate response?

No. There’s no evidence about that whatsoever. In the first place, we don't have any idea, we, certainly it’s bad to feel guilty, it’s unclear, and it’s unpleasant to feel guilty. Whether that leads to poor outcome, I have no idea, and neither does Harold Koenig. And I don't think we have any evidence that they won’t talk to their pastor about it. I think they should talk to their religious, their clergy, because clergy are trained to deal with these issues, and physicians aren’t.

The idea that religion is basically trivialized by scientific study - can you develop that point a bit?

There was this, a very good point, one not taken by people who are interested in bringing religious practices into medicine. If you want to study religion scientifically if you want to bring it into the laboratory of science, then you’ve got to take everything that comes your way.

There was a paper published in the prestigious American Journal of Psychiatry several years ago that essentially suggested that the experience of transcendence, which if fundamental to the religious experience, at least the western religious experience, is associated with disregulation of brain neurochemistry. That’s essentially the point they were making. They showed that the serotonin system in the brain was essentially in the same.

They showed similarities between the regulation of the serotonin system in patients who were deeply religious, as you see in patients with panic disorder. Do you really want to go there? Do the people who want to study religion scientifically want to go there? Do you they want to suggest that religious experience is really a product of brain neurochemistry and nothing more than that? I don't think they do.

But you also start to get into these uncomfortable issues of, is praying to Jesus more effective than praying to Allah?

That is an even more dangerous situation in my regard. The, about the last thing that we want to do is to conduct scientific studies about the health benefits of different religions. Do we want physicians to say to their patients, evidence shows that Christianity is better for you than Judaism, so I think you ought to convert? Now nobody will take that position. Rightly so. But is it any more offensive to take that position than it is to tell somebody who thinks that I, well I go to church once a month, once every couple a months, is it any more offensive to take that position than to tell the person who goes infrequently to church that he or she ought to go more frequently? I don't think so.

You mention along the line of, if you really believe that religion works then why wouldn’t the doctor be going in and saying, religion’s good for you, you must go to church? That’s like saying antibiotics are good for you, so you should take antibiotics. Can you talk to, about that?

Well, no, that’s precisely, that’s, no, that’s well stated. That, if you believe that religion is good for your health, then why wouldn't you as a physician make the recommendation in the same way that you would recommend an antibiotic if you, if somebody had pneumonia?

What about the theory, some who basically try to argue that we are hardwired for religion. What is your response to that kind of, and I know it’s been something the media’s picked up on.

I don't know whether it’s so or not. I really don't know what to say. Religion is ubiquitous and if because it’s so ubiquitous you want to argue that it’s hardwired, I suppose you can, but there are all sorts of things that are ubiquitous that we don't necessarily describe as hardwired, so.

Can you explain the difficulty of isolating religion versus all of these other factors that might make up a complex human being?

Well do you want, the example I gave is the best illustration I think, the example of functional status. That people who didn't go to church were already impaired. Do you want me to reiterate?

If you could, please.

There are a number of studies that show that people who attend religious services more frequently live longer than people who don't. The problem with many of those studies is that the people who go to church more often are different from the people who go to church less often in many other fundamental ways. And it’s very difficult to know which of those ways, whether its church attendance or some of these other factors responsible for these differences in mortality.

The clearest case is the case in which people who are already functionally disabled, and therefore can’t go to church, are more likely to die than people who are healthy. If you look at, I’m not saying this the way you want me to.

Actually can I, I want to address that in another, in a number of other ways. So there’s this evidence suggesting that people who attend church more frequently, attend religious services more frequently live longer than people who don't. There are a number of problems with those studies. In the first place, people attend religious services for any number of reasons, only one of which may be religious devotion. They may attend out of habit. They may attend out of boredom. They don't know what to do on Saturday or Sunday morning. They may attend because it’s something that their family has always done. They may attend for social pressure. They may attend because they’re lonely. They may attend because it’s a good place to develop business contacts. They may attend for all of those reasons. But only one of them is religious devotion.

How do we know which of those reasons is the one that’s responsible for the health outcomes? We don't. Garrison Keillor is supposed to have said that anyone who believes that sitting in church makes you a Christian must also believe that sitting in a garage makes you a car. Which just illustrates the point that sitting in church can mean many different things, and so we have no idea, which it is that may be responsible for these health benefits.

Intercessory prayer studies. Can you first make that distinction between the more general studies and then intercessory prayer studies?

Most of the studies of religion and health are what we refer to as observational studies. We find people who differ in various religious practices and then we look at the health consequences of those practices. The problem with that is that the people differ in many other respects as well.

In a true experiment when you're testing a new drug, for example, you don't have that problem because you can assign some people to receive the drug and others not to receive the drug, and then you contrast the health outcomes. And there’s no ambiguity about what the cause is. If there’s really a difference in health outcomes, you know that it’s due to the drug because all of the other characteristics are, of the two groups are the same. You can’t do that in most of the studies of religion and health because you can’t make some people religious and others not religious; with one exception. And the one exception is these studies of distant intercessory prayer where you actually can conduct an experiment. You can randomly assign some patients to receive the prayer of distant intercessors and other patients not to receive the prayer. In all other respects, the patients may be treated precisely the same. And so if there is an outcome difference, if the recipients of prayer turn out to be healthier or recover faster than the people who don't receive prayer, then you can reasonably conclude that it was the distant prayer that had an effect.

The problem with these studies is, there are many problems with these studies. One of the central problems is that what the investigators control is not prayer in general, but only the prayer of the distant intercessors. But they have no control whatsoever over the prayer of families, friends, the patients themselves, members of religious, congregations, co-workers, neighbors, they have no control over that. So, all we know is that the group that’s receiving the prayers of the distant intercessors is different from the other group in that respect only. But we have no control over the other sources of prayer, so it’s impossible to know how much prayer anybody is receiving, and if you don't know that, then you can’t draw any conclusions whatsoever.
Can you speak to other possible flaws in the intercessory prayer studies?

Well one of the others is that most of the studies collect data on dozens of variables without specifying which they think will be affected by prayer and which won’t be. So, for example, the famous Randolph Byrd study in 1988 measured 26 different outcome variables. Only a few were statistically significantly different between the two groups, very likely a chance finding.

We need to know which of these variables he thinks is going to have the effect. The same is true of the Harris study in 1999, 39 different variables, I believe, in that study. Most of the studies collect loads of variables and then find one or two that distinguish themselves, distinguish the groups one from the other. They’re chance findings.

So, is it always the more variables you introduce the more likely you are to find something?

If you keep looking for differences, sooner or later you’ll find something. And then you say, ah ha, there it is, and you've committed one of the cardinal sins in science.

Are these criticisms that are picked up on by outside observers?

Sometimes and sometimes not. In the most recent studies of distant prayer, studies from Duke and studies from Harvard, both of which were completely negative, the studies were reasonably well designed, and they showed no effect whatsoever of distant prayer.

Did I read that in one study some patients have actually gotten worse when they knew they were being prayed for?

And, in fact, that was the only statistically significant finding that those patients who knew for certain that they were being prayed for did more poorly than the other two groups.

Obviously the media has had a focus on intercessory prayer studies with an objective interest. Why, why not just for the media, but why does the public in general kind of focus in on these particular studies out of all of them?

There’s been a, in the United States there’s been a precipitous decline in understanding of science over the past 50 or 60 years, and a precipitous increase in the willingness to, to validate the subjective. That the only criterion for the validity of something is that it’s heartfelt, and it doesn’t matter whether there’s any evidence for it or, at all. And so we have testimonials about angels, and spirits, and fairies. The bookstores are filled with best sellers about angel medicine, and fairy medicine, and other self-help treatments that have no basis in fact whatsoever. And I think that the willingness to accept something as preposterous as the idea that my thoughts could influence the well-being of somebody on the West Coast is …There’s just an increased willingness to accept virtually anything and, in fact, this is exacerbated by the distrust of, of expertise, scientific or otherwise. So there’s a distrust of science, a misunderstanding of science, and an unwillingness to accept the rules of science for drawing scientific conclusions.

Scientists have said, we haven’t done a good enough job of explaining our position. So, how do you address that or what steps do you take to kind of address this imbalance as you see it?

I’m not sure what to do to address it. The scientific illiteracy in this country is a serious problem, and it impedes the technological society that we’ve grown to embrace. Virtually all of our advanced technological society is based on science that’s been conducted over the past 15 or 20 years. If people want to dispense with science, then they have to give up cell phones, they have to give up flat screen televisions and digital cameras. We have to give up air travel. We have to give up all advanced medicine, all of which have been developed on the basis of science.

What do you think is the future of these kind of medical studies? Where might this field be heading and where might your concerns be for the future?

I don't think we should see the, that intercessory prayer studies should continue, but I’m afraid we will. Even the supposedly definitive studies that have been published in the past year or so, the Mantra Study out of Duke and the Step Study out of Harvard, which were supposed to be definitive, and were, in fact, very large studies. The Harvard study had 1,800 patients in it and it cost 2.4 million dollars. Now, those studies, in my mind, definitively dispensed with the idea that intercessory prayer has any health impact whatsoever. And they were designed to be definitive. But as soon as the negative results came out, and some of the investigators started saying, well maybe they’re not so definitive after all, maybe this, maybe that. They definitively show that there’s no effect.

There are a couple of other issues about intercessory prayer that we have to consider. If we accept the fact that the thoughts or prayers of a group of people in Baltimore can influence the health outcomes of people in Detroit, then we have to throw aside everything we know about consciousness and everything we know about the physical universe. There’s nothing that we know about the physical universe that could account for how somebody’s thoughts or prayers on one side of the country could influence the health of people on the other side of the country.

In physics, we, there are four fundamental forces, that’s it, four. They’re the strong and weak nuclear forces.

There are the strong and weak nuclear forces, which exert their effect only at the subatomic level. There’s gravitational force, which can certainly exert its effects over great distances, but only in proportion to the masses involved. The mass of the human brain, or even the mass of an entire person, is too trivially small that it could not possibility account for the effects of distant prayer. And then there’s electromagnetic force, which is so weak that we can’t measure it even a few inches away from the skull, let alone at great distance, great distances. And so if we accept that there’s an effect of distant intercessory prayer, we have to throw out everything we know about the universe.

Now the proponents of distant prayer say that this is a true scientific revolution. And, of course, we know that scientific revolutions occur. We know that the, the heliocentric, I’m sorry, the terracentric view of the earth, that is that the earth was the center of the universe, was abandoned in favor of the Copernican view that the sun was the center of the solar system. And that was abandoned only very reluctantly. And then we also saw the Newtonian revolution dispense with its, its predecessors in, in physics and astronomy. So there are scientific revolutions, but scientific revolutions require testable and verifiable theories.

There are no cases of scientific revolutions that are not theory based. And there’s no theory of how intercessory prayer could work. Certainly nothing that can be tested. When Newton said, when Newton produced his celestial mechanics, it allowed him to say, Jupiter is in the sky there today, four years, three days, and six minutes from now it’s going to be there. And you can test that and he was right. You could test and verify it. There is no parallel in the distant intercessory prayer literature. We don't know why, in the Byrd study, antibiotics should be affected by distant prayer, but not in the Harris study. What’s the theory that guides us?

Scientists are fond of saying, that exceptional claims require exceptional evidence, and there are certainly exceptional claims in the distant prayer literature, but nothing resembling exceptional evidence.

More generally then would you make the same argument in response to criticism? Maybe those people say, now we may not know everything today, so are you saying, Dr. Sloan that we shouldn’t remain open minded to other possibilities?

Well that line of argument is generally advanced in the case of intercessory prayer. It’s advanced by the proponents of distant prayer. Yes, it, of course, is true that the history of medicine and science in general has proceeded by identifying certain phenomena, even before we understood what produced those phenomena. But the key difference here is that the phenomena were replicable and there were theories that attempted to understand them. Nobody has reproduced the intercessory prayer literature and the intercessory prayer findings; in fact most of the recent studies have been negative.

Some of the proponents of distant prayer have used, by analogy, the case of the discovery that vitamin C is used to treat scurvy long, the citrus fruits were used to treat scurvy long before we understood that the operative mechanism was vitamin C. Absolutely right, absolutely right. But there was no debate about whether citrus fruits treated scurvy, everyone agreed and it was replicable every time. We don't have a parallel case in, in distant intercessory prayer.

Another common criticism of the skeptical position is that we’re not sufficiently open-minded, that skeptics aren’t sufficiently open minded. Carl Sagan said, it’s good to be open minded, but not so good, but Carl Sagan said it’s good to be open minded, but not so open minded that your brains fall out.

How do we define prayer?

Well that’s, that’s another problem associated with the distant prayer literature, that we have no idea what constitutes prayer. One of the most fundamental distinctions that theologians make in prayer is petitionary versus, petitionary prayers versus prayers of praise. I learned about this distinction from a Jesuit colleague of mine many years ago who also looked very skeptically at the distant prayer literature. Ah, largely because, as a Jesuit, he didn't believe in prayers of petition, he didn't believe in prayers of asking for things, he believed only in prayers of praise.

Are there any other thoughts you would like to share?

SLOAN There, well, there are several, apart from the quantity of the scientific evidence, which is extremely weak, there are any number of other reasons why we shouldn’t be bringing religious practices into medicine. We’ve already discussed the ethical issues. There are several other problems, though, some purely practical problems. Everybody complains about how little time physicians have to spend with their patients. It turns out that, even though everybody complains about how little time physicians have for, to spend with patients. So, if they spend some of that precious time involved in spiritual inquires and religious inquires, what is it they won’t cover? Will they not ask about pap smears? Will they not ask about smoking or depression? Will they not ask about diet and exercise? What is it they won’t cover because they spent precious clinical time asking questions about matters of religion and spiritually? That’s a very serious matter.

We already know that if physicians were to follow established practice guidelines for the prevention of disease, guidelines establish by the U.S. Preventive Services Task Force, they would spend 7.4 hours per day doing that and that alone, just following the guidelines of the U.S. Preventive Services Task Force.

Where, that’s just prevention, that’s not treating disease. We also know from studies that patients in cancer prevention, very few patients receive all of the recommended cancer preventive treatments that they’re supposed to, or diagnostic tests, like pap smears, breast self-exams, PSA tests, digital exams. They already don't do enough of that. So, if you take time in the very limited amount of time available in a clinical interaction with a physician and a patient, to devote to religion and spirituality, what won’t you be able to do? That’s a very important consideration.

There’s another consideration. The proponents of bringing religious practices into medicine often cite studies that they claim show that patients want physicians to inquire about their religious practices. And, indeed, there are some studies that show that some patients want physicians to ask about religious practices. But in very few of those studies is it a majority of patients. And you have to look very far into the papers to discover that more patients don't want it, than patients who do want it. And when you ask, as one study did, would you like your physician to ask you questions about religion and spirituality if it means that you weren’t able to discuss an important medical matter, only 10% say yes. And other studies say, indeed, patients have concerns, religious and spiritual concerns about their health, but only 1% of them wants to talk to a doctor about it. So, the suggestion that there’s a great demand on the part of patients to bring religious discussions into clinical medicine is simply wrong.

What about physicians who feel they not only rely on their medical expertise, of course, but are also influenced by their religious background?

I’m not sure that if patients, if that, if physicians say, I’m a Christian physician, or I’m a Muslim physician, or I’m a Jewish physician, and I practice from this perspective, and it informs my practice, and patients know that going in, then I don't think there’s any problem at all. The problem is when patients don't know it, and physicians pursue, essentially a hidden agenda—their agenda, not the patients’ agenda. That’s a problem.

Following up on things you’ve said, I’ve noted your analogy of shooting the holes in the wall and then drawing the bulls eye. It seems to me that there are times when science and religion compete, and then there are times when those who are religious want science to back them up in some ways. I’m wondering how you see it, as one who comes from a science perspective? Are these fields, is there a place where they can, where they can meet, or will they always be apparently kind of competitive?

No, I think, by and large, science and religion are competing ways of understanding the world. And I do think it’s a danger when people who are devoutly religious look to science to support their religious tenets. I think that does a disservice to religion, I think that trivializes the religious experience by attempting to test the tenets of religion. What happens if you submit it to a test and it’s disproven? Do you then abandon your religious faith?

And the distinction is fundamentally between faith and evidence. Science operates on the basis of evidence. Evidence is based on observation and accumulation of data, and scientific theories change as new data are collected. Religion operates according to completely different principles. Religion operates according of the principle of faith, and faith is not amenable to scientific testing. Faith doesn’t require testing; you don't abandon your faith because the data shows something else. If you did it wouldn't be faith.

May I ask why does this field interest you personally? Why have you made the investment in this research in this area of study?

I’ve been concerned about junk science for any number of years, and this field is characterized by a lot of junk science. There’s junk science elsewhere as well and it’s equally offensive, but there’s a lot of bad science in this field. And, and I think the larger question is, are we willing to abandon the world that we have, the scientific and technological world that we have by turning our back on science? Which is what some, but not all, of the proponents of bringing religion into medicine would like us to do.

Doonesbury had a really funny cartoon a few months ago, maybe it was as much of a year ago, depicting somebody who comes into a doctor’s office and discovers that he has a particularly resistant strain to tuberculosis and the doctor asks him, do you want the conventional treatment for TB or the genetically modified version and superior treatment of, for TB? Because, the latter is based on the principles of evolution, and you say you're a creationist. So, which would you like? That’s where the rubber really meets the road. Are you going to, if you’re really a creationist, if, if your really somebody who believes as in, the literal truth of the Bible, and therefore you don't believe in evolution or treatments based on evolution, are you going to turn down a life-saving treatment that is based on the Theory of Evolution because it’s inconsistent with your religious beliefs, and you’ll only accept the one that isn’t?

I’m wondering if you can sort of readdress your, that the whole political nature of this as it exists today, because it seems to me as an observer that science has been sort of back shelved to religion. And I’m wondering if you can articulate it, I can't.

Well, I’m not sure that I can articulate it much better than that. But there are, there are at least four or five different reasons why this interest in religion and health has emerged at the end of the 20th and the beginning of the 21st Century: One is a skepticism about science and increasing scientific illiteracy; a second is these cyclical trends in religion that, ah, trends that show an increase and a decrease, periodically throughout American history; a third is the influence of advocacy foundations, foundations that are interested in promoting a connection between religion and health, and are willing to commit substantial resources to that; a fourth is the political climate of the country which is one in which things religious are esteemed and things scientific not esteemed; probably a fifth is the, ah, or the related concern, skepticism about expertise and credentials in a kind of a false democratization of knowledge. All of those, I think, contribute to the emergence of this trend.

Can you also discuss complementary medicine?

That there’s been the rise in complementary and alternative medicine is undoubtedly related to the rise and interest in religion and health. The complementary and alternative medicine have arisen, in part, because of the dissatisfaction and the way in which medicine is case practiced in the U.S. today. And, though the same is true of the interest in religion and health. And many people regard religious practices and spiritual practices as a, as a part of complementary and alternative medicine.