Focus on Alternative and Complementary Therapies
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Focus Alternat Complement Ther©2005 Pharmaceutical Press
Focus Altern Complement Ther 2006; 11: 101–2
Leslie B Rose
I have some difficulty with the word ‘spiritual’. It has very different meanings depending on who is using it. A theologian’s interpretation might be quite different from a physician’s, but leaving aside religious connotations, it seems to include various aspects of well-being that are difficult to pin down to physical conditions. I also have problems with the word ‘healing’ because to me it means curing disease or trauma. Within the CAM community it probably means something else, and seems to include a range of practices such as therapeutic touch (which apparently need not actually involve touching at all), thought field therapy, various arts-based therapies and the familiar prayer. Now I could be tempted to dismiss all these on the basis of mechanistic implausibility, but I will resist that. The common factor across these practices seems to be some element of interaction with mood, emotion and personal outlook – in other words, keeping up one’s spirits. The question is, how much good do they do?
I will dismiss one claim, however. This is that the well-established scientific method will not work for CAM therapies. The attraction of these to many people, especially ‘healing’, is that they are not scientific, are somehow ‘other worldly’, and are interacting at something other than the physical level. We do have such notions in areas other than medicine – examples are astrology, clairvoyance and a host of paranormal phenomena that people claim to observe. Yet otherwise rational people place CAM in another compartment from orthodox medicine and I am arguing that this is wrong. Astrology and clairvoyance have been repeatedly discredited and are clearly not genuine phenomena. We know this because we have used scientific methods to test them. For this reason, I do not believe that we cannot use scientific methods to test CAM.
Having established that, what does science tell us about ‘healing’? The recent MANTRA II study is a good example.1 This study looked at the effects of intercessory prayer, and a combination of music, imagery and touch therapy in patients undergoing percutaneous coronary intervention. The study found no effect of prayer, or even a suggestion of one. There was a methodological problem in that multiple interventions were used in one arm of this 2 × 2 randomised study so the effects of touch therapy, for example, could not be separated from those of music and imagery. Nevertheless, there was no clinically significant effect of these interventions either. The correspondence arising from this paper is perhaps at least as interesting as the paper itself. One online correspondent asked whether those administering prayer were praying in the most effective manner. My reaction to this is that, if evidence of effectiveness is so elusive that we have to ask such questions, is it worth pursuing at all?
A Pubmed search revealed 17 papers describing clinical trials of intercessory prayer, from 1988 to 2005, including that described above.1–17 While major disparities in methodologies and outcomes make comparisons very difficult, it appears that a higher proportion of the early studies reported positive outcomes, and no positive studies have been reported since 1999, with two exceptions. These are Leibovici’s study,8 which claimed to demonstrate an association between the secondary outcome of hospital-acquired infections in the past and prayer intervention in the present, and Cha and Wirth’s study of in vitro fertilisation.10 The latter paper has been widely criticised; one author has removed himself from the citation and another is in prison for (unrelated) fraud. Nevertheless, the journal concerned refuses to withdraw the paper. Although Leibovici’s study showed no effect on the primary endpoint, the author concluded that ‘retroactive prayer’ should be further investigated and considered for clinical practice. I have to wonder how seriously this suggestion was intended to be taken, unless doctors and patients have access to time travel.
Although prayer is just one practice among many in this field, this crude exercise seems to show diminishing emergence of positive outcomes as time progresses. In other words, the longer we look, the less we seem to see. Resources for research into therapeutics are limited. I have focussed on intercessory prayer because it is an intervention that can be controlled for and blinded, unlike, for example, therapeutic touch and prayer by (rather than for) the patient. The outcomes of clinical trials in prayer have apparently settled down to reveal a negative pattern, which should not be ignored when deciding where to spend research money.
Dónal P O’Mathúna
Empirical research on spiritual healing is relatively new and it would be premature to call a halt to any line of investigation. However, that does not mean that more of the same types of studies are needed.
Recent attention in prayer research has been on intervention studies such as MANTRA II.1 This found no significant differences for the primary and secondary composite endpoints, although some small benefits were reported. A similar pattern of small or no benefit was found in 25 intervention studies of varying quality involving prayer.2 What should we learn from this?
Prayer is a spiritual exercise involving theological beliefs. Prayer research has been fundamentally influenced by theological views, and not always to the benefit of the research. For example, MANTRA II used prayer combined from Christian, Muslim, Jewish, Buddhist and other groups. The researchers chose a complicated research design and prayer mixture to avoid advocating any particular religion. The research was thereby designed around a theology that the type of prayer, and to whom or what prayer is offered, makes no difference. Such an assumption influenced the design of the research and, arguably, strongly influenced the results.
Some prayer studies have used prayer to a personal God while others pray to direct an impersonal energy. In one study the researchers admitted they did not know what the prayer intervention involved. Again, the theological belief appears to be that all forms of prayer are equivalent. This belief leads to interventions that do not match what people do when they pray. They undermine the credibility of any results. And yet the theology is usually not made explicit. This needs to change.
A second theological belief underpinning prayer research is that prayer can be controlled. This is only possible if prayer does not involve a personal being. Yet some of the largest world religions view prayer as an appeal to a personal being who decides how to respond to the request.
Prayer can also be viewed magically, where the divine being is manipulated. Prayer can be viewed as an impersonal energy. In traditions where prayer impersonally leads to a certain outcome, it can be measured. Negative results could be interpreted as evidence that impersonal prayer is not effective – if that is the nature of prayer.
A controlled trial cannot be controlled, however, if a personal being of any sort is determining the outcome. Negative results do not indicate that such a personal being does not exist – they indicate that the researchers have not figured out how to control them; and that leads to theological debate over whether such control is possible. Given that many people are praying to such a personal being, it seems questionable to continue with the sorts of prayer studies exemplified by MANTRA II. They are not addressing prayer as practised by many people.
Why should any research with prayer continue? Much remains to be understood here. The surveys by David Eisenberg and colleagues of US complementary and alternative medicine usage are revealing.3 The findings about people’s use of prayer for healing have received little attention. These surveys consistently show that prayer is the most frequently used approach to healing, used by 25.2, 35.1 and 45.2% of respondents in 1990, 1997 and 2002, respectively. When prayer was divided into subcategories, it ranked first, second, third and sixth in popularity (prayer in general, praying for one’s own health, others praying for one’s health and prayer group participation, respectively). Such popularity invites research. Why do people turn to prayer? Do people who pray have better outcomes or cope better? Does praying in one way or another make a difference?
Research should move away from trying to test prayer as a ‘therapy’ that can be packaged into a controlled intervention. Such an approach is demeaning to the spiritual traditions that cherish prayer. Research should focus on whether people who pray do better. That won’t require theological assumptions about the nature of prayer. If research shows that praying people do have better outcomes, however, it would naturally lead us to wonder about who or what they might be praying to. That will require another debate over the evidence for or against God’s existence.
