STATS ARTICLES 2009
Should health care reform include payment for intercessory prayer?
Rebecca Goldin Ph.D, December 2, 2009
A provision to allow payment for the healing power of third party prayers has been dropped for now - but it's worth going where journalists feared to tread and ask, what's the scientific evidence for prayer?
The merged health care reform bill (Patient Protection and Affordable Care Act), now being considered by the Senate, has dispensed with a controversial provision to pay for “religious or spiritual health care,” a move hailed by many concerned about the separation of church and state. Many news organizations noted the possible constitutional issues with a law that mandates that health insurance cover faith-healing expenses as if they were valid medical costs. Some mentioned the possible child abuse that comes from those who chose prayer over standard medical care for their kids. But few, if any, journalists tackled the fundamental scientific problem with the provision: Is there any evidence that intercessory prayer works?
This is perplexing to say the least: Evidence-based medicine has routinely dismissed the benefit of paid third-party prayer; and yet, the media treated the issue as if it were simply a matter of what would pass muster with the Supreme Court.
The spiritual healing provision was, as the Los Angeles Times reported, originally “inserted by Sen. Orrin G. Hatch (R-Utah) with the support of Democratic Sens. John F. Kerry and the late Edward M. Kennedy, both of Massachusetts, home to the headquarters of the Church of Christ, Scientist.”
The LA Times quoted Dr. Norman Fost, a pediatrician and medical ethicist at the University of Wisconsin, calling prayer “unproven.” But in classic he said/she said reporting, the paper also quoted Phil Davis, a Christian Scientist healer saying that “spiritual treatment... could be the most important solution to healthcare in this country.” Science and belief were treated as if they were identical. The Washington Post touched on the question without providing much in the way of detail, stating only that “Some research has shown a link between prayer and improved health; other studies have not.” So intercessary prayer could be scientifically proven or it could not be scientifically proven - you, the reader, choose. But if you have no idea about what the studies found and how they were carried out, what rational grounds are there for making a choice except your pre-existing beliefs?
There is little doubt that health and religion are intertwined: religion can call for dietary restrictions (such as vegetarianism or a restricted diet), or fasting (for some religions, fasting is for short periods and allows water, for others it’s for longer periods and excludes water). Religious beliefs have an impact on a patient’s likelihood to pursue medical treatment, and as well as their emotional state in handling difficult health situations. Even some of our medical decisions -- such as circumcision, fertility treatment, abortion, organ donation -- are religiously motivated. Many people find great strength in prayer, and through this strength they feel better. And feeling personally/spiritually well may have an impact on our physical health.
But Christian Scientists are not talking about getting payment for a good encouraging talk with your minister or rabbi. They are not talking about an intimate conversation with God to ask for strength to get through chemotherapy. They are talking about intercessory prayer, or prayer said on your behalf by other people.
So, does it make a difference to our health if prayers (by paid professionals) are said for us while we are sick?
The Cochrane Database of Systematic Reviews (sponsored by the Cochrane Collaboration) is a regularly updated evidence-based medicine database. As it notes, “Based on the best available information about healthcare interventions, Cochrane reviews explore the evidence for and against the effectiveness and appropriateness of treatments (medications, surgery, education, etc) in specific circumstances.” The Cochrane is funded by grants and donations, and does not take what they term conflicted funding.
A literature review by Cochrane on third-party prayer led to the conclusion that “the evidence does not support a recommendation either in favour or against the use of intercessory prayer.” It systematically searched MEDLINE and EMBASE for research studies on the effectiveness of such prayer, and included only randomized trials (controlled studies) in its ajudication. Among the studies that qualified for inclusion in the review, there were a few that suggested some benefit to prayer, but the majority did not - and the overall conclusion was that prayer did not show a benefit. In a separate meta-analytic review of the literature published in the Annals of Behavioral Medicine, other scientists found, “There is no scientifically discernable effect for [intercessory prayer] as assessed in controlled studies.”
The point is that many of the benefits attributed to prayer may not in fact be thanks to praying. In particular, it may be the thought that someone cares that has a benefit, rather than the prayer itself. It may be that community promotes health, and that prayer is a means for people to access a community and feel supported during a time of great stress.
Intercessory prayer is not the only possibly way to benefit personally from praying. But whether clergy should be reimbursed, as psychologists are for offering marriage counseling, is not what’s under discussion. Nor are we discussing the benefits of personal prayer to the patients who are themselves involved with prayer-based communities. Here, the benefits have a clearer trend towards benefit. A recent study published in the Journal of Behavioral Medicine found that prayer, reverence and other aspects of faith in postoperative care following coronary artery bypass were associated with fewer complications and a shorter hospital stay. This was not a controlled study, but it suggests that faith gives individuals strength and that has an impact on their health. Such benefits attributed to prayer are not at issue in the discussion about health insurance.