Is Prayer Good for Your Health?

As 2007 drew to a close, news media across the country reported on the usual holiday collection of medical miracles -- stories that almost always end with patients and family members giving credit to the healing power of prayer.

One survivor, a Christian heavy-metal vocalist who was struck in the neck in December's notorious Colorado church shootings, is now recovering, say his friends and fans, with the aid of prayer vigils throughout the United States and Europe.

And Christmas week, a 46-year-old Beach City, Ohio, surrogate mother, who had originally been thought to be carrying only one fetus, delivered a set of healthy twins after a difficult pregnancy. Her niece, the egg donor, announced that the double birth was the result of prayers she had secretly offered for months.

Arising partly out of religious belief and partly out of frustration with high-tech medicine, millions of prayers cross the lips of patients, family members, and even doctors and nurses each day in America's hospitals and examining rooms.

That has prompted a post-2000 wave of research aimed at determining what, if anything, all that praying accomplishes: Can it directly improve patients' health? Does it simply soothe? What happens if the patients aren't told they are being prayed for? And what if they do know -- can patients be harmed by prayer? The answers found so far don't seem to be making anyone feel much better.

Say two prayers and call me in the morning

A 1998 Harvard Medical School survey estimated that 35 percent of Americans pray for good health and that 69 percent of those who pray find it "very helpful" -- a bigger percentage than felt their visits to doctors had been very helpful. A much larger study conducted by the National Institutes of Health in 2002 found 43 percent of people in the United States pray for their own health, and 24 percent seek the prayers of others. Most strikingly, 73 percent of critical-care nurses in a 2005 national survey said they use prayer in their work.

Such results are no big surprise. Most Americans are religious believers and can recount for you any number of stories in which prayer appeared to heal. The highly respected Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University has even set up an "intensive prayer unit" to capture whatever benefits it might provide.

For medical prayer to have an effect, no actual divine or supernatural intervention is necessary; belief alone may give a psychological boost to a recovering patient. Any doctor or scientist wishing to lay bare the healing hand of God or the power of "energy medicine" finds that the placebo effect of prayer is much harder to account for than that of pharmaceuticals, which can be dispensed in controlled doses or replaced by sugar pills.

But one type of prayer experiment does attempt to account for the sugar-pill effect and thereby meet the rigorous statistical requirements of scientific journals. In randomized, double-blind studies, the praying is done by people who aren't in contact with the patients, the patients don't know whether they are being prayed for or not (and in some cases don't even know an experiment is going on), and the doctors and researchers don't know who is praying for whom as they go about treating patients and analyzing the data.

It's through such studies that a small cadre of researchers has been trying in recent years to go straight to the source, to determine whether prayers offered from a distance can heal patients' bodies without passing through their minds. Such "distant intercessory prayer" or "distant healing" studies have also become somewhat of a growth industry. Following only three papers published on the subject between 1960 and 1990 and just four during the 1990s, at least 18 new studies have hit the scientific literature since 2000.

Generous federal and private funding has helped fertilize work in this area, but results so far have been underwhelming. The majority of studies show no significant effects, positive or negative. Some actually find prayer harmful. Others have asked more specific questions: whether the benefits of prayer increase with "dosage" (they don't), whether it matters who does the praying (born-again Christians seem to have an edge, says one observer), and even whether prayers can travel back in time (you'll have to wait a bit for the answer to that one.)

The double-blind double-bind

A type of statistical merger -- called a "meta-analysis" -- of 15 distant-prayer studies, led by researchers at Syracuse University and published in 2006-07, was unequivocal in concluding that "there is no scientifically discernible effect for distant intercessory prayer on health," regardless of how often or how long patients were prayed for.

In contrast, Dr. David R. Hodge, an assistant professor of social work at Arizona State University, believes he has discerned positive effects of distant prayer on the health of patients. His own 2007 meta-analysis covered 17 papers, most of them in common with those covered in the Syracuse study. He did detect small effects, ones that just scraped past the customarily accepted limit at which they can be considered statistically significant.

That, combined with the fact that six of the 17 papers reported at least some positive effects, led Hodge to suggest that more open-minded medical practitioners might consider using prayer.

Although only small effects have been detected so far (no Bible-caliber tales of patients regaining their sight or rising from the dead in these papers), they're nevertheless important, says Hodge. Whether it's an omnipotent Supreme Being or some as-yet unidentified natural force at work, he maintains, the results can be blurred by experimental noise. As he puts it, "If prayer does produce positive outcomes, it is entirely plausible that the effects, as measured by quantitative methods, would be small when assessed in aggregate."

Hodge did take care to run two versions of his meta-analysis, one including and one excluding a controversial 2001 report that distant prayer boosted the success of in vitro fertilization in a Korean fertility clinic. The results, which featured prayed-for women achieving twice the rate of conception as did others, as well as a larger proportion of multiple births, were much more dramatic than others seen in prayer research (and would appear to support the claim of that egg donor in Ohio who prayed for and got twins from her aunt).

The study was soon attacked on several fronts: its allegedly flawed methodology; its renunciation by the original lead author, Dr. Rogerio Lobo of Columbia University; and the conviction on unrelated fraud charges of another author, Daniel Wirth, the person who had organized the Christian prayer groups in the United States that prayed for the Korean women in the study.

But Hodge failed to note the peculiar back-stories of some of the other scientific papers he cited as showing benefits of prayer.

For example, a double-blind 1998 California study found that six months after being prayed for, the health of AIDS patients was significantly better than the health of those who received no prayer. But in 2002, Wired magazine reported that while analyzing the data, the study's authors, having failed to find differences in death rates between the two groups, had "unblinded" the data, looked for other health measures that would show a difference and even searched medical records for other health outcomes that had not been part of the original study, all before re-blinding and reanalyzing the data. Statistical results achieved in such a way are considered unreliable at best.

A 2002 study of 39 patients in an intensive-care unit of an unidentified hospital found that those treated with prayer were released from the hospital sooner than patients who weren't; however, the two groups suffered equally from medical complications. The paper appeared in a predominantly nonresearch publication -- the Journal of Christian Nursing -- alongside articles with titles like "Evelyn and Charles: An Oasis of Love in the ER."

Finally, there was a study published in the British Medical Journal purporting to show that prayer can reach backward through time to aid patients' recovery! In 2000, medical professor Leonard Leibovici coded the identities of all bloodstream-infection patients who'd been treated at Rabin Medical Center in Petah-Tikva, Israel, between 1990 and 1996, and ran them through a random-number generator. He then allocated them randomly into two groups, one of which was then prayed for.

Despite having been hospitalized five to 10 years before the experiment was even conceived, the patients in the prayed-for group had, on average, shorter fevers and were discharged more quickly from the hospital.

In subsequent writing, Leibovici made it clear that he hadn't meant the paper to be taken as serious research; rather, it was to stand as a tongue-in-cheek warning that statistical analyses, no matter how valid, cannot be used to draw nonscientific conclusions. But two doctors in Iowa and Texas responded to Leibovici's work in a subsequent issue of the journal, claiming that advanced physics -- specifically quantum mechanics -- supports the idea of time-traveling prayer.

They even credited Leibovici with what would almost certainly be one of humanity's most amazing achievements, writing that the Israeli professor "may have laid bare a facet of reality -- unity and inseparability of all humans across space and time."

However, the odd phenomena associated with quantum physics have never been shown to occur at any scale above the subatomic, let alone among living beings. Dr. Richard Sloan, professor of behavioral medicine at Columbia University and author of the 2006 book Blind Faith: The Unholy Alliance of Religion and Medicine dismisses the invocation of quantum mechanics by prayer advocates as nothing more than "an intellectually cheap way of cowing the listener by appealing to something no one fully understands."

Like Sloan, Dr. Bruce Flamm, a professor of obstetrics and gynecology at the University of California, Irvine, is a prominent critic of medical prayer research. He has been especially harsh in his analysis of the controversial study of in vitro fertilization patients in Korea, saying that the paper exemplifies many of the fallacies inherent in prayer research. He has written in one of his critiques:

If psychic healers or fortune tellers had claimed to have doubled the success rate of infertility treatments by utilizing tarot cards or Ouija boards, their manuscript would have been immediately rejected as utter nonsense by any legitimate medical journal. Yet, the apparently supernatural results of the Cha/Wirth/Lobo study were accepted and published by a supposedly evidence-based, peer-reviewed medical journal. Why?

Reached by email, Flamm raised another, even more serious argument against prayer in general: "If the creator of the universe actually did respond to intercessory prayer, science would not function. Of course, science does function and quite well." On the other hand, he points out, "if prayer could immediately change the results of a research study, no results of any study on any subject could ever be trusted."

Warning: Prayer may be hazardous to your health

Harold Koenig, a psychiatrist who directs Duke University's Center for Spirituality, Theology, and Health told the journal Nature Medicine in 2005, "Probably saying a 30-second prayer at a key moment has done more good than any psychotherapy or drugs I've prescribed." Whether he was promoting prayer or expressing dissatisfaction with his standard methods, or perhaps both, isn't clear from his statement. But he was clearly assuming that prayer has no negative effects.

That may not be a safe assumption. Consider a 1997 paper examining the possible benefits of prayer for people undergoing treatment for alcohol abuse or dependence. It found that patients who reported that "a family member or friend was already praying for them were found to be drinking significantly more at six months than were those who reported being unaware of anyone praying for them."

What is probably the most widely discussed prayer publication to date -- the Study of the Therapeutic Effects of Intercessory Prayer (STEP) -- also found that prayer may be hazardous to your health. It was conducted by researchers at nine medical institutions, funded by the religious John Templeton Foundation of West Conshohocken, Pa., and published in 2006. The study's results, based on 1,800 patients undergoing coronary bypass surgery, could hardly have been what the researchers had expected.

Among patients who didn't know whether or not they were receiving prayer, the prayed-for and non-prayed-for groups fared the same, so "blind" prayer had no effect. But a third group of patients who were told that they were certain to receive prayer had significantly worse medical outcomes.

Outside observers attributed the negative effects of prayer in the study to phenomena like emotional stress or performance anxiety and suggested that if prayer indeed behaves like a drug that provides no benefits but has potentially harmful side effects, it should not be administered. But the STEP researchers themselves brushed off the one significant finding of their study, writing, "We have no clear explanation for the observed excess of complications in patients who were certain that intercessors would pray for them ... the excess may be a chance finding."

Richard Sloan scoffs at that explanation: "You can bet that if the results had gone the other way, if prayer had shown a positive effect, they would never have attributed that to chance."

Citing the STEP study and others that find pitfalls in prayer, Bruce Flamm warns, "Readers with a scientific world view understand that faith healing does not work but might assume it will at least do no harm. Actually, it can do harm." Some of the broader dangers he points to:

• It can cause patients to shun effective medical care.



• It can lead doctors to diminish their medical efforts.



• It can steer insurers to faith-based interventions.



• It can promote guilt by suggesting that God is somehow punishing a patient with illness or injury and demands penance as the price of recovery.



• It is often linked intimately to prayers for Christian salvation to which a patient might object if informed about it.

Despite what one might expect, Christian evangelicals have no monopoly on remote-prayer research. Much of the work spans several religions or is rooted in New Age spiritualism. The somewhat bafflingly named "Monitoring and Actualization of Noetic Trainings" (MANTRA) study led by Dr. Mitchell Krucoff of Duke University incorporated distant prayer directed at cardiology patients by Muslim, Jewish, Buddhist and Christian devotees, either with and without in-person "music, imagery and touch therapy."

The study, published in 2005, came to a by-now familiar conclusion: "Neither therapy, alone or combined, showed any measurable treatment effect."

While the MANTRA was still in progress, when hopes were still high, journalist Peter Maass followed Krucoff, a cardiologist, through his work day. Before performing an angioplasty on an 80-year-old woman, Krucoff and a nurse practitioner said silent prayers. The prayers were not part of MANTRA, but rather something that the pair did routinely, without patients' knowledge.

This raises the question of whether, having conducted rigorous research showing no statistically detectable benefit of prayer, Krucoff continues to pray for his patients. We can't say for sure -- he declined to discuss the MANTRA study with AlterNet.

But in a commentary on the STEP study's headline-making finding of possible harmful side effects from prayer -- published the year after his own study -- Krucoff and two colleagues wrote that "even well-intentioned intercessory prayer must be scrutinized for safety issues at an equal or even higher level than efficacy measures."

A cosmic vending machine?

Having found apparent benefits of distant prayer in his analyses, David Hodge feels that research on the topic is still in its infancy: "I could see someone making a case for further research on intercessory prayer based upon its wide usage among the general public [and] potential healing effects, and to better understand how it enhances well-being -- assuming that it does at all."

But he hastens to add that distant prayer may not be the best investment: "If I had a limited amount of research dollars, I would be inclined to focus my efforts on the results when a client dealing with a psychological or medical challenge prays, meditates, etc."

Alternative therapies are becoming a bigger part of the healthcare industry every year. The National Institutes of Health have received more than $900 million in congressional appropriations since 1999 to study complementary and alternative medical treatments, everything from green tea for skin cancer prevention to expressive-writing therapy for diabetes patients. But the $2.3 million in grants that NIH awarded for research on prayer during that decade has been among the most controversial money it has spent.

Now the flow of taxpayers' money into prayer appears to be slowing or even stopping. No explicitly prayer-related grants have shown up among those funded by NIH's National Center for Complementary and Alternative Medicine since 2004. But private universities and foundations continue to answer grant applicants' prayers, more than compensating for the decrease in federal funding.

"The countless millions of dollars wasted by groups like the Templeton Foundation on superstitious nonsense could have been used to fund legitimate scientific medical research," says Bruce Flamm. "Sadly, they have squandered vast amounts of money that could have been used to study and perhaps cure many diseases."

Pleased with the curtailment of federal prayer funding, Richard Sloan says, "Private foundations are free to fund stupidly if they want. But we should not be recommending interventions that have no explanation in this universe. It's based on a belief that the universe is a cosmic vending machine -- a belief that you can deposit prayers in the slot and the desired outcome will appear in the hopper."

And if nothing comes out, those recent studies would suggest, don't try tilting the machine.