Intercessory prayer: a therapeutic modality?

June 2002

Regular readers of this column will recognize that I have only occasionally ventured beyond the bounds of infectious disease and infectious disease policy issues and strayed into the morass of complementary and alternative medicine.

Two events lead me to do so again, albeit with a certain amount of trepidation. First, my own employer, the University of Colorado Health Sciences Center, has itself succumbed to the temptations of “whatever the patients want,” and is now surveying members of the health sciences center community to determine their acceptance of and interest in no less than 25 individual complementary or alternative medical “therapies” or “practices.”

There is further the disturbing issue of “credentialling.” How and by whom someone may be “credentialled” to practice reflexology, or aromatherapy, or a host of other “therapies” is an interesting question all by itself. Perhaps that might be worth exploration at another time.

The second event was an observation made by a colleague on the ID faculty, a strong proponent of evidence-based medicine, that a recent issue of the Mayo Clinic Proceedings, December 2001, ventured off the usual beaten path into a discussion of spirituality and medicine, and a study of the effect of intercessory prayer. These two events lead me into this topic.

I have long believed that the increasing attention to complementary and alternative medicine was, although certainly multifactorial in origin, traceable in large part to the depersonalization of medical care. This is due to both the increasing technology of medicine, and the manner in which the “system” has evolved.

No time to talk anymore

Health care has been reduced to laboratory studies and images; rarely, if at all, do patients have an opportunity to simply talk with their physicians. The converse is also true; rarely do physicians have a chance to simply talk with their patients. What is evolving is a contemporary solution to the perceived need for the “laying on of hands.” Is it science? Mostly no. Does it make patients feel better, feel that someone cares? You bet it does.

One of the 25 “therapies” or “practices” listed in the survey referred to was “spirituality/prayer,” although that was not further defined. Two relevant articles were published in the December 2001 issue of the Mayo Clinic Proceedings, together with a thoughtful editorial by Dr. Harold Koening, of Duke University Medical Center. The first was an extensive review of studies dealing with health effects of spirituality and religion published from 1970-2000, carried out by Dr. Paul Mueller and members of his staff in the Division of General Internal Medicine at the Mayo Clinic.

In summary, their review indicates that there is a quite substantial body of studies that appears to show that religious involvement and spirituality are positively associated with improved health outcomes, as measured by longevity, health-related quality of life and other positive health outcomes. Coping skills, even during terminal illness, appear to be improved. Conversely, there is correspondingly less anxiety, depression and suicide among such individuals. Some studies suggest that recovery from illness may be facilitated or enhanced when spiritual needs of patients are addressed.

Part of the effect is likely due to avoidance of risk behaviors and pursuit of health-promoting behaviors, but the psychosocial, behavioral and perhaps even biological processes that may bring about these effects are not at all understood.

Which brings me to intercessory prayer. This is the topic of the second article in the journal. This was a randomized, double-blind, controlled trial of the effect of intercessory prayer on cardiovascular disease progression in patients discharged from a coronary care unit in Rochester, Minn.

Patient experiences

I, and I suspect many of you, have had an occasional professional experience in which a patient experienced a wholly unanticipated recovery, or some other event that seemed totally beyond scientific explanation. My mind is open, I believe, to the possibility that there may from time to time be divine intervention in a patient’s living or dying. Yet, it would never occur to me that such an event or events could be studied in the setting of a randomized, controlled clinical trial. There is simply no basis for study of such events within our scientific constructions of human pathophysiology.

The methodology used was virtually beyond reproach. The study was conducted in the years 1997-1999, and included 799 eligible patients <18 years who agreed to participate. The patients were randomized at hospital discharge to a control or intercessory prayer (IP) group within 24 hours, and standard cardiovascular care was provided to both groups.

The patients were divided into high- and low-risk groups on the basis of five commonly accepted risk factors. A total of 215 intercessors were recruited from local religious or community interest groups; each intercessor prayed for a mean of 7.4 patients, at least once a week for a total of 26 weeks, or until a primary end-point occurred. Primary end-points included death, cardiac arrest, coronary revascularization, CV rehospitalization or emergency department visit for CV disease. Intercessors had no contact with patients.

Intercessory prayer had no significant effect on medical outcomes in this study. This was not the first study of intercessory prayer, nor is it likely to be the last. It was, however, carefully done, although the investigators readily point out some of the possible weaknesses in their discussion. Nonetheless, the results were not surprising, at least to this observer. Imagine the shock, if you will, of a significant result favoring intercessory prayer! That would surely challenge our scientific paradigms. It is important to note, however, that this study in no way invalidates any of the issues discussed above relating to the association of spirituality and health.

“Disease at once affects and is affected by what we call the emotional life. Thus, the physician who attempts to take care of a patient while he neglects this factor is as unscientific as the investigator who neglects to control all the conditions that may affect his experiment … The good physician knows his patients through and through, and his knowledge is bought dearly. Time, sympathy and understanding must be lavishly dispensed, but the reward is to be found in that personal bond which forms the greatest satisfaction of the practice of medicine. One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.” — Francis Weld Peabody, Harvard Medical School, 1928.