Monday, April 10, 2006
Normally we at Pallimed are right on top of things, finding you the most interesting and best studies from the world of hospice and palliative medicine, but one slipped under our radar, probably because it does not seem to immediately relate to palliative medicine.
A new study was released last week about intercessory prayer for healing/improving outcomes in patients. The study was published in the American Heart Journal in the April issue. The Study of Therapeutics Effects of Intercessory Prayer (STEP) took patients about to undergo CABG and randomized them with informed consent into 3 groups.
1) Those receiving intercessory prayer but blinded (prayer but uncertain or PBU)
2) Those not receiving intercessory prayer but blinded (no prayer but uncertain or NPBU)
3) Those receiving prayer but unblinded (prayer but certain PBC)
Now what is intercessory prayer? Basically it is the act of praying on behalf of another person in an attempt to intercede in their life usually through a benevolent divine being, as opposed to 'black spells', the 'evil eye' and 'curses' which are used to bring harm upon another. There have been a couple of well publicized studies (often with cardiac patients) including one by a local Kansas City doctor William Harris (an officer of the Intelligent Design Network) in the late 1990's. The STEP trial is the largest blinded randomized control trial to date to study intercessory prayer.
In the STEP trial, the idea was to test if it was the prayer itself or the knowledge/certainty about being prayed for that was being tested. The primary outcomes showed no difference in complications or 30-day mortality for groups 1 & 2 (PBU and NPBU). Thus most media outlets reported that prayer has no effect (here, here, and here).
But the researchers also found that Group 3, (PBC) who knew they were being prayed for had more complications (59%) than either Group 1 (PBU) (52%) or Group 2 (NPBU) (51%).
In the discussion section the authors state that the statistically significant difference "may have been a chance finding." A chance finding? I have never seen that offered as an explanation for a statistically significant finding in a research study. Could it be that the prevailing notion that prayer as a therapeutic intervention has been presupposed as only causing benefit without the potential to cause harm? Was it the certainty of being prayed for that caused the harm? Something like, "Oh my gosh...someone is praying for me? It must really be bad! Maybe I will worry so much to cause more complications?" The study does not go into detail on this matter. The authors are even quoted as stating 'They can't come to any conclusions and that the effect of prayer is neutral.' Which is interesting given the statistically significant finding noted above.
Obviously one of the difficulties in studying intercessory prayer is that we have no scientifically plausible mechanism for the effect. While this should not stop us from studying that which we do not know, it should encourage us to be more free of bias since there is so much uncertainty in this area.
Multiple other criticisms abound from pro-prayer camps and non-prayer camps but if you read this far your attention span is probably getting very very short, so I'll just summarize some of them briefly, you can do your own exposition:
- We can't study God. He is unknowable.
- We shouldn't test/predict God.
- The prayers were prescribed as opposed to allowing the prayers to use their custom prayer thereby diminishing the possible effectiveness of prayer.
- We should not give the patients the knowledge of prayer because that may harm them.
- Different denominations (Catholic and Unity) should not be used. It may decrease the effectiveness of prayer.
- 45% of patients refused entry into the study.
- Not published in JAMA as it was initially submitted to them.
So what does this have to do with palliative care? Well, hospice and palliative care is very open to the role spirituality and religion play in the lives of our patients and their families. Often we talk of reframing hope and praying for multiple different outcomes not just cure, especially when our experience and knowledge inform us that survival is very unlikely. I never tell people to stop praying for miracles but I often encourage them to pray for other things as well. Studies like this have the possibility for showing there is little demonstrable effect from prayer or that there is a profound effect, but the power of prayer and religion in healing (and here I mean curing) is so great that regardless of the money spent you will never be able to unseat the strongly held beliefs of those that believe in the power of prayer and those that do not.
And I am done writing.....
NB: The $2.4M study was founded by the Templeton Foundation, designed to study the interface between science and religion.
NB: In the same issue here are the names of some of the other study acronyms: GRACE, ESSENCE, and MIRACLE. No joke. And none of them are studying prayer. Kind of funny coincidence.
NB: Free PDF editorial of the article in AHJ is here.