New Reports Cover Old Ground
Studies claiming to find efficacy for prayer and health benefits for religious belief are based on flawed research

by Kevin Courcey RN

Two medical reports published in June of this year deserve a more critical view than they have received in the press. The first, by John A. Astin, et al., was published in the Annals of Internal Medicine and funded by a grant from the National Center for Complementary and Alternative Medicine. It consists of a literature review of studies on “distant healing.” This term usually denotes remote, intercessory prayer or positive directed thoughts, but the authors also included Therapeutic Touch in the review, since it, too, claims to be directing healing energy at a distance-albeit a small one.

The authors reviewed the relevant medical databases for studies on the subject, and found over 100. Of these, only 23 were of sufficient quality to warrant review. While the authors admit that methodological limitations in the research they reviewed “make it difficult to draw definitive conclusions about the efficacy of distant healing,” they assert that since 57% (n=13) of these flawed studies showed some positive response to at least one measured variable, the interventions must warrant further study. The studies they reviewed, however, do not support such a conclusion.

Only two of the five reviewed studies on prayer claimed positive results reaching significance: Harris’ CCU study and Byrd’s cardiac inpatient study. In the Harris study, the authors measured 33 different variables and found no significant difference between the prayer group and the control group. In fact, the prayed-for patients had a higher rate of readmission to the Coronary Care unit, a higher rate of pneumonia, longer hospital stays, even a higher mortality rate. It was only when the researchers imposed an arbitrary global “hospital course” rating scale on the data that they were able to “discover” a positive response in the prayer group. As reported in the Scientific Review of Alternative Medicine, five pre-existing medical conditions have been shown to have been over-represented in the control group in Harris’ study. Consequently, the control group started off with a 62% higher rate of patients with acute pulmonary edema; a 31% higher rate of patients with heart valve disease; an 18% higher rate of patients who had a history of previous heart attacks; a 10% higher rate of diabetics; and a 10% higher rate of patients with chronic kidney failure. No pre-existing conditions were similarly over-represented in the prayer group. This could easily account for the difference between the groups. In fact, had the authors taken these preexisting conditions into account, the control group would likely have outperformed the prayer group.

The Byrd study also failed adequately to control for pre-existing conditions, with the control group having more admission diagnoses of acute heart attacks, more cardiac arrhythmias, more heart valve disease, even fifty percent more patients admitted with cardiac arrest. Despite this obvious handicap, the prayed-for patients still needed more medication for heart pain, had more unstable pain, had a higher percentage of re-admissions to the coronary care unit, and needed 4 times the number of temporary pace makers and three times the number of permanent pace makers as that of the control group. Yet, both studies were judged by Astin’s review as showing significant positive results for prayer.

Several of the eleven Therapeutic Touch (TT) studies reviewed by Astin claimed positive results, but when taken as a group, they present a clear picture of the randomness of results one would expect to achieve by chance or placebo response alone. The results of two anxiety studies contradict each other. The two pain studies listed contradict each other, and another showed no significant treatment response at all. A series of five studies conducted by a single researcher run the gamut from significant response to treatment, no response to treatment, and significant response to placebo. This wide variation in results is to be expected when measuring nonefficacious treatments.

When one takes into account the numerous flaws in methodology, the strength of the response to placebo treatments, the wide variations in results even from the same researcher, and negative physical outcomes consistently associated with reported positive findings, it becomes clear that this genre of studies has not borne fruit despite repeated attempts by committed researchers.

The second report being published is yet another “review” of previous studies - this time with a focus on the impact of church attendance, religiosity, and personal prayer on health. Despite the lead author’s contention that he “approached the analysis with a healthy measure of skepticism,” Michael McCollough is a well-known supporter of this genre. He is the primary researcher at the National Institute for Healthcare Research, an organization funded by the Templeton Foundation, which is dedicated to documenting only positive links between spirituality and health. The studies, many of which have already been critiqued as using flawed research methods and arriving at unjustified conclusions, do not add up to support for a link between religiosity and health. Richard P. Sloan, whose paper published last year in the premier British medical journal Lancet found flaws in virtually every study cited by supporters of the religion/health link, commented that this latest attempt to make the link fails once again. “[The researchers] in fact did a very good, solid, methodical job, and what it showed is no relationship,” said Sloan in an interview with HealthScout, an on-line health news site. “It’s not even statistically significant,” he noted. As an example, Sloan pointed out that smokers are nine times more likely to die of lung cancer than non-smokers, which represents a 9:1 ratio, and is a very strong correlation. Even a 3:1 correlation is considered strong, but the correlation found in McCollough’s review was only 1.29:1, which is statistically insignificant.

A major problem with both Astin’s review of distant healing, and McCollough’s review of religiosity and health, is that they appear to believe that if they cite enough studies, even if they are flawed, they will eventually build a case for prayer or church attendance having a positive link to health. But if a study is flawed in its methodology, you simply cannot trust its results; even if you have 28 other flawed studies saying something similar. If we can detect the flaws, we must either re-evaluate the data or discard the study. And the flaws in these studies are very evident: they forget to take into account baseline health status, the age of the participants, their socioeconomic status, pre-existing chronic conditions, their current medication usage, etc.

In summary, there is nothing new in either of these reports. Just a rehashing of old material, and a new public relations drive to link religious belief and prayer to better health.

Interestingly, another report released the same week could easily be seen as contradicting the contention that the Christian god intervenes in health matters. The World Health Organization released its data on life expectancy around the world, and the United States, where the predominant religion is Christianity, came in 24th. Japan, whose populace tend to follow either the polytheistic Shinto religion or Buddhism, came in first. One might suggest that their prayers for good health are being answered more effectively than those praying to the Christian god. Perhaps if McCollough and his peers are sincerely interested in our health and longevity, they should be counseling our conversion to Buddhism.

Studies Mentioned In This Report

Astin, John A., et al. “The Efficacy of ‘Distant Healing’: A Systematic Review of Randomized Trials.” Annals of Internal Medicine (2000) 132: 903-910.

Harris, William S., et al. “A Randomized, Controlled Trial of the Effects of Remote, Intercessory Prayer on Outcomes in Patients Admitted to the Coronary Care Unit.” Archives of Internal Medicine (1999) 159: 2273-2278.

Byrd, R. C. “Positive therapeutic effects of intercessory prayer in a coronary care unit population.” South. Med J. (1988) 81: 826-829.

Courcey, Kevin M. “An Analysis of ‘A Randomized, Controlled Trial of the Effects of Remote, Intercessory Prayer on Outcomes in Patients Admitted to the Coronary Care Unit’.” Scientific Review of Alternative Medicine (2000) in press.

McCollough, Michael. “Religious Involvement and Mortality: A Meta-Analytic Review.” Health Psychology (2000) Vol. 19, No. 3: 211-222.

Copyright © 1996, 1997, 1998, 1999, 2000 by American Atheists.